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Multilesion coronary angioplasty: clinical and angiographic follow-up
Insights
Restenosis after multi-lesion percutaneous transluminal coronary angioplasty (PTCA) is common in symptomatic patients (82%) but rare in asymptomatic ones (30%). Recurrent symptoms often indicate severe, multi-lesion restenosis.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common procedure for coronary artery disease.
- Determining restenosis rates after multi-lesion PTCA is crucial for defining expanded indications.
- Understanding factors influencing restenosis is key to improving patient outcomes.
Purpose of the Study:
- To determine the restenosis rate after multi-lesion PTCA.
- To compare restenosis rates between symptomatic and asymptomatic patients.
- To identify predictors of restenosis after multi-lesion PTCA.
Main Methods:
- Retrospective study of 209 patients who underwent successful multi-lesion PTCA.
- Restudy of 55 symptomatic and 74 asymptomatic patients an average of 7 months post-dilation.
- Analysis of restenosis rates, severity, and location, with multivariate analysis for predictors.
Main Results:
- Restenosis rate was 82% in symptomatic vs. 30% in asymptomatic patients (p<0.001).
- Multi-lesion restenosis occurred in 47% of symptomatic vs. 14% of asymptomatic patients (p<0.05).
- Proximal LAD disease, lesion length, male gender, and diabetes predicted increased restenosis.
Conclusions:
- Multi-lesion PTCA improves symptoms in most patients.
- Recurrent symptoms are often linked to severe, multi-lesion restenosis.
- Restenosis at multiple sites is uncommon in asymptomatic patients.
Abstract:
Determination of the restenosis rate after multilesion percutaneous transluminal coronary angioplasty is an important consideration in defining expanded indications for the procedure. Of 209 patients who underwent successful multilesion coronary angioplasty, 55 symptomatic and 74 asymptomatic patients were restudied an average of 7 +/- 4 months after dilation. The restenosis rate was 82% (45 of 55) in the symptomatic patients and 30% (22 of 74) in the asymptomatic patients (p less than 0.001). Only 4% of the asymptomatic patients had restenosis at more than one dilation site. When only patients who developed a restenosis were considered, the restenosis occurred at more than one dilation site in 47% (21 of 45) of the symptomatic group versus 14% (3 of 22) of the asymptomatic group (p less than 0.05). When all recurrent stenoses were examined, the severity of the luminal narrowing was greater than or equal to 70% in 64% (45 of 70) of the stenotic lesions in the symptomatic patients versus 31% (8 of 26) of the stenotic lesions in the asymptomatic patients (p less than 0.05). Proximal left anterior descending coronary artery disease, increased length of the stenotic narrowing, male gender and diabetes were associated with an increased incidence of restenosis by multivariate analysis. Patient-related variables were not predictive of multilesion restenosis. In conclusion, the majority of patients are clinically improved after multilesion coronary angioplasty. Recurrent symptoms after multilesion coronary angioplasty are frequently associated with multilesion restenosis and a more severe degree of restenotic narrowing. Restenosis at more than one dilation site is uncommon in the asymptomatic patient.(ABSTRACT TRUNCATED AT 250 WORDS)