Comparison of angioplasty and bypass surgery in multivessel coronary artery disease

The role of coronary angioplasty in the treatment of patient with multivessel coronary artery disease has not been fully established. We compared immediate and 1-year follow-up results in 60 patients undergoing coronary angioplasty for multivessel coronary disease in 1982 with 41 patients anatomically suitable for angioplasty but who underwent elective coronary bypass surgery during the same time period. Baseline variables were similar in both groups except for number of vessels diseased which was higher in the surgical group. Angioplasty was initially successful in 70% of cases. There were no deaths. Mean initial hospital days were lower in the angioplasty group. At follow-up there were no significant differences in survival, functional class, occurrence of subsequent myocardial infarction or use of cardiac medications. However, 33% of the successfully dilated patients required either repeat dilatation or subsequent bypass surgery because of restenosis or inadequate initial revascularization. The statistical power of the study was limited due to the small sample sizes. While demonstrating that angioplasty can be successfully performed in patients with multivessel disease, definitive conclusions about the comparability of the two treatments are hampered by possible selection bias and small patient numbers. This issue could be better addressed by a multicenter prospective randomized trial.