Circulation, Vol 87, 831-840, Copyright © 1993 by American Heart Association
WS Weintraub, ZM Ghazzal, JS Douglas Jr, HA Liberman, DC Morris, CL Cohen and SB King 3d
BACKGROUND. Restenosis remains a critical limitation after coronary
angioplasty. There is little information comparing long-term prognosis in
patients who suffer from restenosis and others who do not. The purpose of
this paper is to determine the clinical events in patients with restenosis
or continued patency documented by restudy coronary arteriography. METHODS
AND RESULTS. The source of data was the clinical data base at Emory
University. Patients who had previous coronary surgery and patients who
underwent angioplasty in the setting of acute myocardial infarction were
excluded. A total of 3,363 patients undergoing angiographic restudy 4
months to 1 year after angioplasty were compared with 3,858 not undergoing
restudy. In the restudy population, 1,570 had restenosis and 1,793 had
patent arteries at all sites dilated. The restenosis patients were older
and had more hypertension, more diabetes, more severe angina, more
multivessel coronary artery disease, more severe stenoses, and less
satisfactory original results. At restudy, in patients without restenosis,
38.7% had angina versus 70.7% in patients with restenosis (p < 0.0001).
There were few deaths in the first 6 months. At 6 years, the survival rate
was 0.95 without restenosis and 0.93 with restenosis (p = 0.16). At 6
months and 6 years, freedom from myocardial infarction was 0.97 and 0.88
without restenosis and 0.93 and 0.85 with restenosis (p = 0.0001). On
multivariate analysis, restenosis was an independent correlate of
myocardial infarction but not mortality. At 6 months and 6 years, freedom
from coronary bypass surgery was 0.99 and 0.94 without restenosis and 0.91
and 0.78 with restenosis (p < 0.0001). At 6 months and 6 years, freedom
from repeat angioplasty was 0.96 and 0.76 without restenosis and 0.44 and
0.20 with restenosis (p = 0.0001). The highest event rates were noted in
the patients with restenosis with recurrent chest pain. Patients not
undergoing restudy differed somewhat from the study group, and there were
far fewer repeat revascularization procedures in the group not undergoing
restudy. CONCLUSIONS. Patients with restenosis are more likely to have
recurrent angina pectoris. Although there is no or little difference in
survival, there is a difference in myocardial infarction rate in the
patients with and without restenosis. The low myocardial infarction and
death rates in the group suffering restenosis may be related to repeat
revascularization in these patients; the principal events in the restenosis
population are frequent repeat revascularization procedures.
ARTICLES
Long-term clinical follow-up in patients with angiographic restudy after successful angioplasty
Andreas Gruentzig Cardiovascular Center, Department of Medicine, Emory University School of Medicine, Atlanta, Ga. 30322.
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