Copyright © 1987 by the European Society of Cardiology.
© 1987 The European Society of Cardiology
Restenosis and its determinants in first and repeat coronary angioplasty
Department of Medicine, Montreal Heart Institute 5000 East Belanger Street, Montreal, Quebec, Canada HI T 1C8
*Section of Cardiology, Department of Medicine, University of Berne Medical School Inselspital, 3010 Berne, Switzerland
Received 23 June 1986; revised 21 October 1986; .
Dr Hanj J. Rapold, Section of Cardiology, Department of Medicine, University of Berne, Medical School, Inselspital, CH-30140 Berne, Switzerland.
Abstract
Restenosis is the main problem limiting long-term success of percutaneous transluminal coronary angioplasty (PTCA) and is most accurately evaluated by follow-up angiography. We compared the primary and long-term results of angioplasty in 268 consecutive patients (293 segments) with first PTCA (PTCA 1, angiographic follow-up 98%) and in 66 patients (76 segments) with repeat PTCA after restenosis (PTCA 2, angiographic follow-up 92%). Forty clinical, angiographic and procedural factors were assessed in relation to outcome. Primary success rate was higher in PTCA 2 (91% vs 67.5%) and major complications were fewer (4.5% vs 16%).Higher inflation pressure (7.9 ± 2.3 vs 6.8 ± 1.8 atm, P<0.005) and larger balloons (3.5 ± 0.5 vs 3.2 ± 0.5mm, P< 0.005) were used for PTCA 2, resulting in lesser residual stenosis (33 ± 16± vs 40 ± 18%, P <0.05). Restenosis rate (>70%) after PTCA 1 and after PTC A 2 (27% vs 36%, P = NS) and the mean time to recurrence (4.7 vs 5.3 months, P = NS) were similar. Procedural factors were the main determinants of long-term success in primary PTCA. The restenosis risk was independently related to residual stenosis >45% (P<0.001), variant angina (P<0.05) and multivessel disease (P<0.05) after PTCA 1 and to male sex (P<0.001) and higher inflation pressure (P<0.05) after PTCA 2. Mild to moderate intimal tearing was associated with less restenosis after PTC A 1, but not after PTCA 2. Including 9 patients (10 segments) with a third PTCA, 70% of the 66 patients with repeat PTCA had a successful long-term outcome. Repeat angioplasty should therefore be considered as an integral part of PTCA therapy. Restenosis however remains a major concern. An optimal primary result with a minimal residual stenosis is decisive for first PTCA, whereas avoidance of a dissection by using lower inflation pressure on a restenosis might improve the long-term outcome of repeat PTCA.
Key Words: PTCA • restenosis • repeat PTCA • PTCA outcome determinants
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