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Repeat coronary angioplasty as treatment for restenosis
Insights
Repeat coronary angioplasty is effective for first restenosis, offering high success and functional improvement. However, efficacy may decrease after a second restenosis, requiring careful revascularization decisions.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Repeat coronary angioplasty is standard for first restenosis.
- Long-term outcomes of this strategy require definition.
Purpose of the Study:
- To evaluate the long-term outcomes of repeat coronary angioplasty for restenosis.
- To assess the efficacy and safety of subsequent angioplasty procedures.
Main Methods:
- A study of 465 patients undergoing a second coronary angioplasty at the same site.
- Follow-up for a mean of 40.5 months, including assessment of revascularization procedures, myocardial infarction, mortality, and functional status.
Main Results:
- Second angioplasty had a 96.8% success rate with low procedural complications.
- Long-term follow-up showed sustained functional improvement in 88% of patients.
- A trend toward diminished efficacy was observed after a second restenosis.
Conclusions:
- Repeat coronary angioplasty is effective for restenosis with good functional outcomes.
- Careful consideration of revascularization options is needed for patients with multiple restenoses.
Abstract:
Repeat coronary angioplasty has become the standard approach to a first restenosis. However, the long-term outcome of such a strategy is not well defined. In the present study, 465 patients (mean age 58 years [range 27 to 79], 53% with multivessel disease) underwent a second angioplasty procedure at the same site. The procedure was successful in 96.8% with a 1.5% rate of in-hospital bypass surgery, a 0.9% incidence rate of myocardial infarction and no procedural deaths. Four hundred sixty-three patients (99.6%) were followed up for a mean of 40.5 months. Forty-nine patients (10.6%) underwent a third angioplasty procedure at the same site, 55 (11.8%) had coronary bypass surgery and 33 (7.1%) underwent angioplasty at a different site. During follow-up, 12 patients (2.6%) sustained a myocardial infarction and 21 (4.5%) died including 13 (2.8%) with cardiac death. Of the 442 surviving patients, 88% experienced sustained functional improvement and 78% were free of angina. The actuarial 5-year cardiac survival rate was 96% and the rate of freedom from cardiac death and myocardial infarction was 92%. For the subgroup of 49 patients who had a third angioplasty procedure at the same site, the success rate was 93.9% with a 2% incidence rate of myocardial infarction. There were no in-hospital deaths or coronary artery bypass operations. The mean follow-up interval for this subgroup was 30.5 months with a 22.4% cross-over rate to coronary bypass surgery, a 4.1% incidence rate of myocardial infarction and a 2% cardiac mortality rate. At last follow-up, 89% of patients had sustained functional improvement and 76% were free of angina. The combined angiographic and clinical restenosis rate was 48%. Repeat angioplasty as treatment for restenosis is an effective approach associated with a high success rate, low incidence of procedural complications, and sustained functional improvement in combination with an acceptable rate of bypass surgery. However, there is a trend toward diminished angioplasty efficacy after a second restenosis. Thus, decisions for further revascularization should be made after careful review of available options.