J.Jpn. Surg. Soc.. 97(3): 191-196, 1996

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Feature topic

REASONABLE INDICATION FOR PTCA OR CABG IN JAPANESE PATIENTS WITH CORONARY ARTERY DISEASE
―ON THE BASIS OF 11 YEARS FOLLOW-UP―

The principle of our treatment choices for either PTCA or CABG is as follows ; 1) 1VD is mainly indicated for PTCA or medical treatment except for very proximal or complicated LAD lesion, 2) 3VD is absolutely indicated for CABG, 3) 2VD involving LAD is positively indicated for CABG, 4) Special indications were set aside for critical lesion(s) in limited groups of patients such as those with prior CABG, and those with other serious or fatal disease, and also senile but active patients (male＞80 years old, female＞75 years old). Proper medial treatment was always conducted in all cases. During the period of 11 years between 1984 and 1994, 1050 PTCA procedures (760 individual patients) and 1484 CABG’s were done at our university hospital. The annual ratio between CABG and PTCA (CABG/PTCA) was higher than 2.0 in the first 4 years but it has settled on a level of 1.0±0.2 in the last 5 years even with a significant increase in the number of PTCA patients. As to the characteristics of our PTCA group, patiens with single vessel lesion comprised 57％, only single target PTCA did 78％ and only LAD did 47％. Patients with prior CABG and multi lesion PTCA comprised 10％ and 22％, respectively. The lesion success rare was 89％.
As the major complications in 1050 PTCA’s, one death (0.1％), seven (0.7％) emergency CABG’s and eleven (1.0％) Q wave MI patients were recognized. The overall angiographical lesion restenosis rate was 44％ of 657 lesions in 550 patients who underwent CAG within 6 months after PTCA. In 1484 CABG’s, hospital mortality was 1.5％and non fatal major complications 6％.
The survival rates (free of cardiac death) for PTCA patient appeared equivalent between single and multi vessel groups. However, their event free survival rates even for IVD significantly dropped, from 99％ to 68％ in one year and below 60％ at 5 years. For 3VD it became as low as 26％ at 10 years. On the contrary, the even free survival rates for CABG patients with 3VD keep as high as 93％ at 5 years and 75％ at 10 years, respectively.
As a conclusion, the timely use of PTCA considering an indication of CABG may be a wise and practical treatment choice for CAD, but the reasonable ratio of PTCA vs CABG seems to be about fifty-fifty as indicated in our study results. Our treatment decisions of either PTCA or CABG as mentioned above yielded acceptable outcomes in the prognosis of patients with CAD.

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