Patients with multiple-vessel coronary artery disease were once considered poor candidates for angioplasty because of the high incidence of re-stenosis. Before the widespread use of stents with angioplasty, surgical intervention with coronary artery bypass grafting (CABG) resulted in better clinical outcomes for these patients. Kornowski and associates evaluated the clinical outcomes of patients with multiple-vessel disease treated with angioplasty, including stent placement when indicated, compared with patients who had single-vessel disease treated in a similar manner.
A consecutive series of 2,339 patients treated with stents at a cardiology research center between 1994 and 1997 were enrolled in the study. Patients were grouped according to whether single-vessel or multiple-vessel disease (two or more lesions) was present. All patients underwent electrocardiography before and after surgery, and blood samples were obtained every eight hours postoperatively to measure creatine kinase MB (CK-MB) enzyme levels. Clinical outcomes at one year were assessed by telephone interviews, and any late clinical events were documented.
Basic demographic information was similar between groups, although patients in the single-vessel group were more likely to have had angioplasty and CABG and a recent history of myocardial infarction. The indications and types of stents used were similar between groups, as were the lesion configurations and measurements. Overall, success rates after the procedure, major in-hospital complication rates, and other potential early postoperative complications were the same between groups. Of note, however, was the increased incidence of CK-MB “leak” in the multiple-vessel group. Long-term follow-up revealed no differences in mortality rates or in the number of revascularization procedures between groups, and the event-free survival curves were the same.
The authors conclude that angioplasty with stent placement may be a viable alternative to CABG in treating selected patients with multiple vessel coronary artery disease, primarily those with two-vessel disease. Success rates and both short- and long-term outcomes are similar in patients with either type of vessel disease.