Key result
Post-PTCA restenosis occurs in ~30% of patients, predicted by clinical and angiographic procedural factors.
Why the study?
Risk factors for restenosis after successful coronary angioplasty in patients with single-vessel disease were not fully determined.
Do specific clinical, angiographic, and hemodynamic factors predict restenosis in patients undergoing elective coronary angioplasty for single-vessel disease?
Cohort (n=998)
Do specific clinical, angiographic, and hemodynamic factors predict restenosis in patients undergoing elective coronary angioplasty for single-vessel disease?
Restenosis following plain old balloon angioplasty (PTCA) is multifactorial and strongly predicted by suboptimal immediate procedural results (high residual stenosis or gradient) and target vessel (LAD).
Identified restenosis factors may refine risk stratification post-angioplasty; leaves open prospective validation of targeted prevention strategies.
To determine risk factors for restenosis, we studied 998 patients who underwent elective coronary angioplasty (PTCA) to native coronary arteries between July 1980 and July 1984. Restenosis, defined as a luminal narrowing of greater than 50% at follow-up, was present in 302 patients (30.2%). Univariate analysis of 29 factors revealed seven factors related to restenosis: vessel dilated (circumflex coronary artery 18%, right coronary artery 27%, left anterior descending artery 34%; p less than .01), final gradient of 15 mm Hg or less compared with greater than 15 mm Hg (27% vs 38%, p less than .01), duration of angina greater than 2 months compared with angina of shorter duration (27% vs 35%, p = .01), post-PTCA stenosis of 30% or less compared with 31% to 50% (28% vs 36%, p less than .025), stable vs unstable angina (26% vs 34%, p less than .05), presence vs absence of intimal dissection (26% vs 32%, p = .07), and female gender vs male gender (25% vs 32%, p = .08). Multivariate analysis revealed five factors independently related to increased risk of restenosis in the following order of importance: PTCA in the left anterior descending artery, absence of intimal dissection immediately after PTCA, final gradient greater than 15 mm Hg, a large residual stenosis after PTCA, and unstable angina. Restenosis after PTCA is a multifactorial problem. The hemodynamic and angiographic result at the time of PTCA significantly influences long-term outcome, but additional measures aimed at reducing the rate of recurrence of atherosclerotic plaque are required.
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Leimgruber et al. (1986) conducted a cohort in Single-vessel disease undergoing elective coronary angioplasty (n=998). Clinical and angiographic risk factors vs. Reference patient groups was evaluated on Restenosis (luminal narrowing >50% at follow-up). LAD dilation, final gradient >15 mm Hg, large residual stenosis, unstable angina, and absent intimal dissection independently predicted restenosis, which occurred in 30.2% of PTCA patients.
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