Detection of Restenosis After Percutaneous Transluminal Coronary Angioplasty by an Angiographic Score

BACKGROUND: Restenosis, or ÒAchilles heelÓ of balloon angioplasty, remains in a range near 30% and cannot be predicted with certainty. To find adequate methods for its foresight is a challenge. OBJECTIVES: To determine risk factors and an angiographic score to predict the appearance of restenosis after one-site percutaneous transluminal coronary angioplasty (PTCA). METHODS: We restudied prospectively 315 (239 men, 76 women, age range from 29 to 78, 53.6 +/- 9.5 years) of 360 patients who underwent PTCA to a native coronary artery. The study didnÕt include patients with left main disease, total occlusion, side-branch involvement, ostial stenosis, acute phase of myocardial infarction or those who repeat PTCA. Two-hundred twenty-eight patients underwent PTCA of the left anterior descending artery, 56 of the right coronary artery and 31 of the left circumflex artery. RESULTS: Restenosis, defined as a luminal renarrowing > 50% at follow-up, was present in 82 (26%) patients between 1 and 8 months after the procedure. Univariate and multivariate analysis revealed four vascular factors related to restenosis (p < 0.05): a) lesion length and; b) irregularity of the lesion borders before PTCA; c) perivascular and/or endovascular haziness and; d) intensity of residual stenosis after PTCA. To construct the score, a zero was given to a lesion length < 8 mm; to smooth lesion borders; to residual stenosis up to 20%; and to absence of haziness after PTCA. A one was given to a lesion length between 8 and 10 mm; and to a lesion with irregular borders. A two was given to a lesion length > 10 mm. A three was given to a residual stenosis > 20%; and to the presence of haziness after PTCA. The sum of all terms was considered the final score. So, it could oscillate from 0 to 9. Calculated score from 0 to > 5 showed respective restenosis rates of (%): 5.2; 15.1; 24.0; 39.4; 44.8; 60.8; and 84.2. The calculated correlation coefficient (0.98) among the scored values and the correspondent restenosis rates was highly significant (p < 0.001). CONCLUSIONS: It is concluded that restenosis is primarily a multifactorial problem based on vascular factors and may be predicted with a high degree of probability by the proposed score.