Long-term follow-up of coronary angioplasty: the 1977-1981 national heart, lung, and blood institute registry

Abstract

Between September 1977 and September1981, 1587 consecutive patients underwent a first coronary angioplasty (PTCA) at 16 clinical centres. After excluding patients with prior coronary bypass surgery (CABG) and left main or minimal vessel disease, 1390 were available for in-hospital and long-term follow-up. Mean duration of follow-up was 5·9 years (range 0–9·0 years). PTCA was successful (all attempted lesions reduced ≥ 20%) in 882 patients (63·4% and, overall, 624 patients (44·9% had complete (COREV) and 766 (55·1%) incomplete (INCOREV) revascularization or a failed PTCA. In-hospital events included death in 0·7 myocardial infarction (M1) in 5·0% and CABG in 24·0% of patients. Patients with COREV had significantly lower rates of these events than the INCOREV group. At 6 years, mortality in all registry patients was 6·5% and MI rate 15·0% CABG was performed after the initial hospitalization in 15·5% of patients and repeat PTCA in 19·1%. All events, except repeated PTCA, were less frequent in the COREV than the INCOREV group. Among patients with a successfulflrst PTCA, cumulative 6-year mortality was 5·8% and incidence of MI 10·8%; 16·9% underwent CABG and 24·7% repeat PTCA during follow-up. CABG was slightly more frequent in INCOREV than COREV patients with successful PTCA, but all other events were similar in the two groups, suggesting that INCOREV ‘by intent’ has a good prognosis. In patients with INCOREV, mortality and incidence of MI were higher during follow-up for patients with multivessel rather than single vessel disease. However, the incidence of CABG and repeat PTCA was similar in the two groups. Thus patients successfully treated by PTCA have a low event rate during follow-up (<1% annual mortality and <2% annual MI rate). However, repeat PTCA was required in 25% of patients and INCOREV led to a relatively high incidence of CABG during follow-up.