[Pulse pressure as a predictor of restenosis after percutaneous transluminal coronary angioplasty]

The tension of the arterial wall increases the proliferation of the vascular smooth muscle cells which is one of the basic mechanisms of the reocclusion after percutaneous coronary intervention (PCI). The aim of the study was to evaluate the significance of the pulse pressure (PP) in predicting the restenosis after PCI.

We retrospectively studied 84 patients (average age 53.9 +/- 10.1; 69 males and 15 females)--35 patients with angiographically proved restenosis and 49 patients without restenosis matched according to age and gender. The pulse pressure in the ascending aorta was measured before PCI. The standard angiographic measurements took place before PCI and immediately after it. The restenosis was defined as recurrent stenosis > 50% on the follow-up angiogram which was performed up to 9 months after PCI.

The mean pulse pressure was significantly higher in patients with restenosis (76.9 +/- 24.2 mmHg vs 61.3 +/- 17.5 mmHg, p < 0.001). The incidence rate of restenosis was 28.6% for the patients with the lowest PP and 55.2% for the patients with the highest PP (p < 0.05). The odds ratio after adjustment for sex, age, smoking status, hypercholesterolemia, diabetes mellitus, the type of lesions that underwent the PCI, maximal inflation pressure, time of inflation, minimal lumen diameter before and after the PCI, reference lumen diameter, stent implantation and mean blood pressure was 1.0, 2.83 (0.59-13.72) and 7.36 (1.12-68.11) for the patients with the lowest, middle and highest PP, respectively. The multiple-adjusted analysis showed that 10 mmHg increase in PP is associated with 72% increase in risk of restenosis (OR 1.72, CI 1.14-2.60, p < 0.01).

Ascending aortic pulse pressure is an independent predictive factor for restenosis after percutaneous coronary intervention.