Key Points
- To assess the true angiographic incidence, clinical presentation, and functional impact of restenosis following delayed coronary angioplasty in patients who received thrombolytic therapy for acute myocardial infarction.
- Prospective evaluation of 300 consecutive post-thrombolysis myocardial infarction patients undergoing delayed percutaneous transluminal coronary angioplasty (PTCA) at a mean of 10.5 ± 6 days post-infarction.
- Follow-up coronary angiography performed at a mean of 7.3 ± 1.9 months in 205 of the 253 patients (81%) who achieved initial procedural success.
- Multivariate regression analysis to determine independent clinical and angiographic predictors of vessel restenosis and complete reocclusion.
- Angiographic restenosis (>50% luminal narrowing) occurred in 105 of 205 patients (51%), of whom 68% (71/105) were completely asymptomatic and 13% (27/205) developed total vessel reocclusion.
- Vessel reocclusion was independently predicted by small reference diameter (P < .0005) and pre-existing collaterals (P < .01), whereas non-occlusive restenosis was predicted by baseline TIMI flow grade ≤ 2 (P < .0001).
- Left ventricular ejection fraction was significantly preserved in patients with patent vessels (56.1 ± 13.4%) and non-occlusive restenosis (56.0 ± 13.8%) compared with those suffering complete reocclusion (46.4 ± 13.0%, P < .01).
Structured PICO
PPopulation300 consecutive patients with recent myocardial infarction treated by thrombolysis who underwent delayed percutaneous transluminal coronary angioplasty (PTCA) of the infarct-related lesion.
IInterventionDelayed percutaneous transluminal coronary angioplasty (PTCA) of the infarct-related lesion performed at 10.5 +/- 6 days after the myocardial infarction.
OOutcomeAngiographic restenosis (defined as the recurrence of > 50% stenosis) at mean 7.3 +/- 1.9 months follow-up.surrogate
Despite a low incidence of recurrent symptoms, delayed PTCA of the infarct-related lesion after thrombolysis is associated with a high rate of angiographic restenosis (51%), which is predominantly clinically silent.