Related Experiment Videos
Repeat interventions as a long-term treatment strategy in the management of progressive coronary artery disease
K G Lehmann1, A C Maas, R van Domburg
1University of Washington School of Medicine, Seattle, USA.
Insights
Repeat coronary interventions effectively manage chronic coronary artery disease, improving patient function and slowing stenosis progression. This strategy offers a rational approach for long-term care, demonstrating favorable outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Coronary artery disease (CAD) is a chronic, progressive condition requiring long-term management strategies.
- Percutaneous coronary interventions (PCI) offer theoretical benefits for controlling CAD progression through repeated application.
- The long-term outcomes of repeat PCI for CAD management have not been extensively studied.
Purpose of the Study:
- To investigate the efficacy of repeat coronary interventions in managing ischemic symptoms and angiographic lumen narrowing over an extended period.
- To assess the long-term functional and anatomical outcomes of patients undergoing multiple PCI procedures.
- To compare outcomes between different patterns of repeat interventions: restenosis, new stenosis, or both.
Main Methods:
- Analysis of 544 patients who received two or more PCI procedures over 13 years from a cohort of 4,357 interventions.
- Patients were stratified into three groups: restenosis (same segment), new stenosis (different segment), or both.
- Evaluation of clinical outcomes, including angina severity, mortality, myocardial infarction, and need for coronary surgery, alongside angiographic data.
Main Results:
- Repeat procedures were performed 2-5 times per patient, with shorter intervals between procedures in the restenosis group.
- Significant long-term improvement in angina severity (New York Heart Association class) was observed across all groups, from 3.2 to 1.6.
- Mortality and coronary surgery rates were similar between restenosis and new stenosis groups; restenosis showed a lower rate of myocardial infarction.
Conclusions:
- Repeat interventional treatment for newly acquired coronary stenoses is a rational approach for long-term CAD management.
- This strategy leads to sustained functional improvement and effectively controls the progression of clinically significant stenoses.
- Favorable late outcomes, including reduced myocardial infarction rates in the restenosis group, support the use of repeat PCI.
Objectives:
This study investigates whether repeat coronary interventions, applied over an extended time period, can successfully curtail the progression of ischemic symptoms and angiographic lumen narrowing.
Background:
Coronary artery disease is a chronic and generally progressive disorder, and potential treatment strategies should be examined and compared with this chronicity in mind. Percutaneous interventional revascularization procedures could theoretically be useful in controlling progression of the disease through repeated use as new coronary lesions arise. However, the outcome of this long-term management concept has not previously been subjected to detailed investigation.
Methods:
From a consecutive series of 4,357 interventional cardiac procedures, 544 patients were identified who received two or more interventions during the 13-year study period. These patients were categorized into one of three groups: restenosis (repeat interventions limited to the same target segment, n = 261), new stenosis (all repeat interventions directed to stenoses not previously treated, n = 155) or both (repeat interventions directed both to the same and to different target lesions, n = 128).
Results:
Two to five procedures were performed per patient; the time period (mean +/- SD) separating each procedure was significantly less (p < 0.0001) for the restenosis group (4.2 +/- 2.3 months) than for the new stenosis (24.2 +/- 23.5 months) or the "both" groups (11.4 +/- 11.0 months). Despite the need for repeat procedures, the severity of angina (mean New York Heart Association functional class 1.6 +/- 0.9) after 6.2 +/- 2.3 years of follow-up was substantially better than before the initial procedure (mean functional class 3.2 +/- 0.8), with a similar magnitude of change found in all three groups. This long-term functional improvement was mirrored by a corresponding anatomic improvement, with the mean number of diseased vessels remaining constant at the time of each procedure (1.5 +/- 0.7, 1.5 +/- 0.7 and 1.6 +/- 0.7, respectively, for the first, second and third procedures, p = NS). The restenosis and the new stenosis groups also demonstrated statistically similar annual rates of mortality (1.9% vs. 1.8%) and coronary surgery (2.3% vs. 2.6%), although the restenosis group had a lower rate of infarction (1.4% vs. 3.2%, p = 0.002).
Conclusions:
Repeat interventional treatment of newly acquired stenoses provides a rational approach for the long-term management of chronic coronary artery disease. In addition to yielding a favorable late outcome, the use of this strategy can result in sustained functional improvement and can check the progression of clinically significant stenoses.