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Published on: January 28, 2020
Predictors of early reangiography within 30 days after coronary stenting
Christine Scholten1, Michael Schemper, Peter Probst
1Department of Cardiology, University of Vienna Medical School, Vienna, Austria. christine.scholten@univie.ac.at
Insights
Identifying predictors for early reangiography after coronary stenting can reduce unnecessary procedures. Hypertension and left ventricular hypertrophy are key clinical indicators for unplanned reangiography, even with good short-term outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Prediction
Background:
- Many early reangiographies post-coronary stenting show no significant coronary abnormalities.
- Characterizing patients undergoing early reangiography can help avoid unnecessary procedures.
Purpose of the Study:
- To identify predictors of unplanned early reangiography using data available at stent implantation.
- To reduce the incidence of potentially unnecessary reangiography procedures.
Main Methods:
- A case-control study compared 71 patients with early reangiography to 88 matched controls without reangiography.
- Clinical and procedural variables were analyzed to identify predictors of early reangiography.
- Analysis also compared clinical parameters between patients with negative and positive reangiograms.
Main Results:
- Clinical predictors for early reangiography without coronary pathology included hypertension, left ventricular hypertrophy, and total cholesterol.
- Angiographic predictor: multiple vessel disease.
- Procedural risk factors: left anterior descending artery target, type B/C lesions, LAD total occlusion, and high-pressure balloon deployment.
Conclusions:
- Clinical, angiographic, and procedural factors predict the risk of unplanned early reangiography after coronary stenting.
- Hypertension and left ventricular hypertrophy are independent predictors, potentially mimicking acute coronary events.
- These findings aid in risk stratification and potentially reducing unnecessary reangiography.
Background:
A substantial number of early urgent reangiographies after coronary stenting do not reveal coronary abnormalities such as thrombosis, dissection, restenosis or side branch occlusion. The characterization of patients undergoing early reangiography may reduce the number of potentially unnecessary procedures.
Objective:
To evaluate the predictors for unplanned early re- angiography on the basis of the information available at the time of stent implantation.
Methods:
All 71 patients with reangiography after stent implantation between 1994 and 1998 in the Department of Cardiology at the University Hospital of Vienna, Austria, were compared with a control sample of 88 patients without early reangiography during the same period (control subjects were matched for the time point of the first intervention). The clinical and procedural variables were analyzed in this case-control study. For specification of the group with negative reangiograms, differences in clinical parameters between patients with negative versus patients with positive reangiograms were also analyzed.
Results:
Clinical predictors for early reangiography of patients without evidence of important coronary pathology were a history of hypertension and left ventricular hypertrophy, as well as total cholesterol. The angiographic predictor was multiple vessel disease, and procedural risk factors included the left anterior descending artery as the target artery, type B and C lesions and total occlusion in the left anterior descending artery, as well as high-pressure balloon stent deployment.
Conclusion:
Clinical, angiographic and procedural variables predict the risk for unplanned early reangiography after coronary stenting. Hypertensive heart disease may mimic acute coronary events; hypertension and left ventricular hypertrophy represent independent predictors of unplanned reangiography in patients with good short-term results.
