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Late symptom recurrence after successful coronary angioplasty: angiographic outcome
C G Suresh1, S C Grant, R A Henderson
1Department of Cardiology, Wythenshawe Hospital, Manchester, UK.
Insights
Recurrent chest pain after successful percutaneous transluminal coronary angioplasty (PTCA) is often due to new coronary lesions or worsening stenosis, not restenosis of the dilated artery. Most treated coronary segments maintained a good angiographic appearance long-term.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Recurrent chest pain following successful percutaneous transluminal coronary angioplasty (PTCA) necessitates investigation into its causes.
- Understanding the long-term angiographic status of treated coronary arteries is crucial for patient management.
Purpose of the Study:
- To evaluate the angiographic appearance of dilated coronary arteries in patients experiencing recurrent chest pain over a year post-PTCA.
- To identify the primary causes of late-onset angina after successful coronary angioplasty.
Main Methods:
- Retrospective analysis of coronary angiograms from 112 patients.
- Review of case histories for patients with chest pain >1 year after initial PTCA.
Main Results:
- New or worsening coronary lesions accounted for 50% of recurrent chest pain cases.
- Restenosis was identified in only 11% of patients; 84% of dilated lesions showed no restenosis.
- 30% of patients had no significant stenosis in either treated or untreated coronary segments.
Conclusions:
- The majority of coronary segments treated with PTCA maintain good angiographic appearance long-term.
- Late-onset angina post-PTCA is predominantly caused by new coronary artery disease or progression of existing mild stenosis, rather than restenosis of the treated site.
Objectives:
To determine the angiographic appearance of the dilated coronary artery and the cause of symptoms in patients who presented with a return of chest pain more than 1 year after successful percutaneous transluminal coronary angioplasty (PTCA).
Design:
Retrospective analysis of coronary angiograms and review of case histories.
Patients And Methods:
112 patients who underwent repeat coronary arteriography for investigation of chest pain 13-105 (median, 30) months after successful coronary angioplasty were studied. All patients were free of symptoms for at least 12 months after the initial angioplasty.
Results:
A return of chest pain was attributed to restenosis in 12 patients (11%), to a new lesion or worsening of pre-existing coronary lesion in 56 patients (50%), and to both restenosis and stenosis in non-dilated coronary segments in 10 patients (9%). There was no restenosis in 112 of the 134 dilated lesions (84%). In 34 patients (30%), there was no significant stenosis in either dilated or non-dilated coronary segments.
Conclusions:
In patients undergoing coronary angiography for the investigation of recurrent chest pain more than 1 year after successful coronary angioplasty, the majority of dilated coronary segments had a good angiographic appearance. Late onset angina following PTCA is usually due to new coronary lesions or worsening of pre-existing mild stenosis.