Copyright © 1989 by the European Society of Cardiology.
© 1989 The European Society of Cardiology
Bilateral mammary artery surgery or percutaneous transluminal coronary angioplasty for multivessel coronary artery disease? An analysis of effects and Costs
Catharina Hospital, Department of Cardiopulmonary surgery Eindhoven
* Catharina Hospital, Department of Cardiology Eindhoven
** Technical University Eindhoven, Department of Statistics Eindhoven
University Maastricht, Department of Health Economics Maastricht
Erasmus University Rotterdam, Department of Clinical Epidemiology, Rotterdam The Netherlands
Address for correspondence: E. Berreklouw MD, Catharina Hospital, Department of Cardiopulmonary Surgery, Michelangelolaan 2, 5602 ZA Eindhoven, The Netherlands
Seventy-two patients with stable or unstable angina treated since 1983 by multivessel-PTCA(MVP) were retrospectively compared with 44 similar patients that were suitable for MVP, but who had undergone bilateral mammary artery (BIMA) surgery (and additional vein grafts in 60·5% of the patients) since 1986. Both groups were comparable (P = not significant [NS])for gender, age, most risk factors, objective ischaemia and left ventricular function; however, in the BIMA group there were more previous infarctions (P = 0·02), hypertension (P = 0·03), three-vessel disease (P = 0·0001), and less severe angina (P = 0·007). In the BIMA group, a mean of 3·1 (range 2-5) vessels were treated and in the MVP group 2·0 (range 2–3) vessels (P = 00001). Both groups were almost completely revascularized (NS). In 39·5% of the BIMA group, no veins were used and in 20·9% the BIMAs were used as sequential grafts. In-hospital mortality was comparable: 2·3% for BIMA and 1·4% for MVP, so were periprocedural infarctions (13·6% vs 8·3%), rethoracotomies (9·1% vs 0% ), emergency procedures (0% vs 5·7% ), low cardiac output (2·3% vs 5·6%) and other complications (18·2% vs 9·2%). The mean stay (days) on the ICU/CCU for BIMA was 2·3 and for MVP 1·6 (P = 0·005) and the mean hospital stay for BIMA 12·3 and for MVP 6·6 (P = 00001). The maximum and mean follow-up (months) of43 BIMA and 71 MVP hospital survivors was 35 vs 72 and9·5 vs 22·3 (P = 00001) with a late mortality of 0% and 4·2% (NS). MVP patients, including 12 with re-procedures, had more recurrent angina (17·7% vs 4·7%, P<005) and more often used anti-anginal medications (62·0% vs 18·6%, P<0000I). Late complications (excluding re-procedures) were comparable for MVP and BIMA (20% vs 9·3%, 4·4% vs 0%, 9·2% vs 14%). MVP patients had more re-hospitalizations (34 vs 5, P<0·0001), re-catheterizations (33% vs 2·3%, P<0·0001) and cardiac re-procedures (16 vs 0, P = 0·0006) than BIMA patients. Recurrent-angina-free survival at 1 year was 96% after BIMA and 64% after MVP (P<001). Event-free survival at 1 year was 86% after BIMA and 58% after MVP (P < 0·05).
Cost analysis revealed that MVP can initially be performed at half of the costs of BIMA, but the cost of M VP rises within 2 years to 67% of the cost of BIMA, due to re-procedures and the continued use of anti-anginal medications. Thus, the relationship between effects and costs of M VP might become equal to that of BIMA within 2 years, after which the results will probably be in favour of BIMA.
Key Words: Coronary bypass surgery • internal mammary artery • bilateral mammary artery bypass surgery • percutaneous transluminal coronary angioplasty • multivessel percutaneous transluminal coronary angioplasty • cost
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  J. B. Wong, F. A. Sonnenberg, D. N. Salem, and S. G. Pauker Myocardial Revascularization for Chronic Stable Angina: Analysis of the Role of Percutaneous Transluminal Coronary Angioplasty Based on Data Available in 1989 Ann Intern Med, December 1, 1990; 113(11): 852 - 871. [Abstract] [PDF]
|
|