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(Circulation. 1999;100:910-917.)
© 1999 American Heart Association, Inc.

Clinical Investigation and Reports

Influence of Pre-PTCA Strategy and Initial PTCA Result in Patients With Multivessel Disease

The Bypass Angioplasty Revascularization Investigation (BARI)

Kevin E. Kip, PhD; Martial G. Bourassa, MD; Alice K. Jacobs, MD; Leonard Schwartz, MD; Frederick Feit, MD; Edwin L. Alderman, MD; Bonnie H. Weiner, MD; Melvin B. Weiss, MD; Mirle A. Kellett, Jr, MD; Barry L. Sharaf, MD; Alexios P. Dimas, MD; Robert H. Jones, MD; George Sopko, MD; Katherine M. Detre, MD; for the BARI Investigators

From the Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pa (K.E.K., K.M.D); Montreal Heart Institute, Montreal, Canada (M.G.B.); Boston Medical Center, Boston, Mass (A.K.J.); Toronto Hospital, Toronto, Canada (L.S.); New York University Medical Center, New York, NY (F.F.); Stanford University Medical Center, Palo Alto, Calif (E.L.A.); University of Massachusetts Medical Center, Worcester, Mass (B.H.W.); New York Medical College, Valhalla, NY (M.B.W.); Maine Medical Center, Portland, Me (M.A.K.); Rhode Island Hospital, Providence, RI (B.L.S.); Cleveland Clinic Foundation, Cleveland, Ohio (A.D.); Duke University Medical Center, Durham, NC (R.H.J.); and the National Heart, Lung, and Blood Institute, Bethesda, Md (G.S.).

Correspondence to Kevin E. Kip, PhD, University of Pittsburgh, Graduate School of Public Health, 130 DeSoto St, 127 Parran Hall, Pittsburgh, PA 15261. E-mail kip{at}edc.gsph.pitt.edu

Background—In PTCA patients with multivessel coronary artery disease, incomplete revascularization (IR) is the result of both pre-PTCA strategy and initial lesion outcome. The unique contribution of these components on long-term patient outcome is uncertain.

Methods and Results—From the Bypass Angioplasty Revascularization Investigation (BARI), 2047 patients who underwent first-time PTCA were evaluated. Before enrollment, all significant lesions were assessed by the PTCA operator for clinical importance and intention to dilate. Complete revascularization (CR) was defined as successful dilatation of all clinically relevant lesions. Planned CR was indicated in 65% of all patients. More lesions were intended for PTCA in these patients compared with those with planned IR (2.8 versus 2.1). Successful dilatation of all intended lesions occurred in 45% of patients with planned CR versus 56% with planned IR (P<0.001). In multivariable analysis, planned IR (versus planned CR), initial lesions attempted (not all versus all intended lesions attempted), and initial lesion outcome (not all versus all attempted lesions successful) were unrelated to 5-year risk of cardiac death or death/myocardial infarction but were all independently related to risk of CABG.

Conclusions—Overall, a pre-PTCA strategy of IR in BARI-like patients appears comparable to a strategy of CR except for a higher need for CABG. Whether the use of new devices may attenuate the elevated risk of CABG in patients with multivessel disease and planned IR remains to be determined.

Key Words: angioplasty • coronary disease • revascularization

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