Multiple lesion transluminal coronary angioplasty in single and multivessel coronary artery disease: acute outcome and long-term effect.

Multiple lesion transluminal coronary angioplasty was performed in 428 patients. Angioplasty was attempted in 1,047 lesions (2.4/patient), with an angiographic success achieved in 94%: 2 lesions were attempted in 74%, 3 in 21%, 4 in 5% and 5 or more in 1% of cases. A clinical success was achieved in 404 (94%) of the patients: 95% with and 93% without prior surgery and in 94% of those with single vessel disease and 94% of those with multivessel disease. Significant complications occurred in 17 patients (4.0%): 11 (2.5%) had a transmural infarction, 9 (2.1%) required urgent surgery and 6 (1.4%) died. An apparent lesion recurrence occurred in 106 (26%) of 404 patients with 81 of 89 patients (91%) having a successful second angioplasty. A second apparent lesion recurrence occurred in 15 patients (19%), with 13 of the 15 patients having a successful third angioplasty. A sustained clinical improvement (mean follow-up period 28.3 +/- 16 months) was obtained in 208 (83%) of 250 patients with successful angioplasty. The cumulative probability of survival at 51 months was 93% in these 250 patients. Survival was adversely affected by the presence of prior bypass surgery (no prior surgery 97% versus prior surgery 81%; p less than 0.05). These data suggest that multiple lesion angioplasty can be successfully performed with a good success rate, an acceptable incidence of complications and a reasonable expectation of satisfactory long-term clinical improvement.