Bilateral mammary artery surgery or percutameous transluminal coronary angioplasty for multivessel coronary artery disease : an analysis of effects and costs

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