Revascularization of dysfunctioning myocardium: differential prognostic effects of coronary artery bypass grafting and percutaneous transluminal coronary angioplasty in patients with three-vessel disease and mostly viable myocardium

摘要

In patients with left ventricular dysfunction, multivessel coronary disease and viable myocardium, little is known on the differential prognostic effect of coronary artery by pass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA). To this purpose, 177 patients with previous myocardial infarction, three-vessel coronary disease and an EF < 0.40 underwent CABG (group A, 114 patients) or PTCA (group B, 63 patients). Viability was demonstrated by maintained Thallium-201 uptake in more than 70% of left ventricle in 95/114 and 51/63 patients of groups A and B, respectively. Revascularization was greater in the CABG group (2.9(+-)1.2 graft/patient) as compared to the PTCA group (1.3(+-)1.2 treated vessel, P < 0.05). Intraoperative mortality was 6.7 and 6.3% in groups A and B, respectively. At 6 months, viability was highly predictive of improvement of symptoms and wall motion abnormalities. Survival at 4 years was 90% in CABG and 92% in PTCA patients with maintained viability, while cumulative hard event rates showed an event-free survival of 86 and 76% in groups A and B, respectively (log rank: 0.0035). In patients with three-vessel coronary disease, low EF and mostly viable myocardium, coronary revascularization was associated with a favourable 4-year survival, even if CABG was superior to PTCA in reducing cumulative events.