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Correlation of residual stenosis immediately after coronary angioplasty with long-term prognosis
S Miyazaki1, K Nakao, S Daikoku
1Division of Cardiology, National Cardiovascular Center, Suita, Osaka, Japan. smiyazak@hsp.ncvc.go.jp
Insights
Residual stenosis after coronary angioplasty impacts long-term prognosis. Higher residual stenosis correlates with poorer outcomes, including cardiac events and overall survival, in patients with successful procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Prognosis
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common treatment for coronary artery disease.
- The impact of residual stenosis after successful PTCA on long-term outcomes requires further clarification.
Purpose of the Study:
- To evaluate the correlation between residual stenosis (RS) after successful PTCA and the long-term clinical prognosis.
- To identify independent predictors of long-term survival and cardiac events following PTCA.
Main Methods:
- A cohort of 592 patients with successful PTCA for de novo lesions were categorized by RS (<15%, 15-35%, 35-50%).
- Kaplan-Meier survival analysis and Cox proportional hazard regression were used to assess outcomes over a median follow-up of approximately 1670 days.
- Primary endpoint was all-cause mortality; secondary endpoint was cardiac events.
Main Results:
- Significant differences in survival rates were observed among the three RS groups.
- Survival curves were dependent on the degree of post-procedural residual stenosis.
- Multivariate analysis identified age, ejection fraction, and residual stenosis as independent determinants of event-free, cardiac, and total survival.
Conclusions:
- Residual stenosis immediately after successful balloon coronary angioplasty is an independent predictor of long-term clinical prognosis.
- Minimizing residual stenosis during PTCA is crucial for improving patient outcomes.
- Further research may explore optimal RS thresholds for different patient populations.
Abstract:
This study evaluated the correlation of residual stenosis after percutaneous transluminal coronary angioplasty with the long-term prognosis. Among consecutive 1,230 patients who underwent coronary angioplasty in the National Cardiovascular Center in Osaka, Japan, 894 patients had de novo lesions. Of these, the 70 patients with acute myocardial infarctions and 105 with unstable angina who had emergency coronary angioplasties were excluded from the study. Among the remaining 719 patients, successful dilatation of the main target vessel was achieved in 592 patients, who then comprised the study group. They were divided into three groups according to their residual stenosis (RS) immediately after coronary angioplasty: group A, RS < 15% (n=208); group B, 15% < or = RS < or = 35% (n=286), and group C, 35% < RS < 50% (n=98). The duration of follow-up was 1,668, 1,660, and 1,680 days in group A, B, and C, respectively. The groups A, B, and C were not significantly different in terms of age, history of myocardial infarction, left ventricular ejection fraction, number of diseased vessels and target vessels, and risk factors such as hypertension, hyperlipidemia, and diabetes mellitus. Primary end point of follow-up was defined as death from any cause and the second end point was occurrence of cardiac events. Kaplan-Meier survival analysis showed significant differences among the three groups. Moreover, survival curves seem to be dependent on the degree of post-procedural residual stenosis. Multivariate analysis using a Cox proportional hazard regression model showed that age, ejection fraction, and residual stenosis were independent determinants of event-free, cardiac, and total survival. Residual stenosis immediately after coronary angioplasty is an independent contributor to long-term clinical prognosis in patients treated with successful balloon coronary angioplasty.