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(Circulation. 1999;99:1290-1294.)
© 1999 American Heart Association, Inc.

Clinical Investigation and Reports

Prior Cytomegalovirus Infection and the Risk of Restenosis After Percutaneous Transluminal Coronary Balloon Angioplasty

Christoph Manegold, MD; Marwan Alwazzeh, MD; Helmut Jablonowski, MD; Ortwin Adams, MD; Martin Medve, MD; Beate Seidlitz, MD; Ulrich Heidland, MD; Dieter Häussinger, MD; Bodo-Eckehard Strauer, MD; Matthias P. Heintzen, MD

From the Klinik für Gastroenterologie, Hepatologie, und Infektiologie (C.M., M.A., H.J., M.M., B.S., D.H.); the Institut für Medizinische Mikrobiologie und Virologie (O.A.); and the Klinik für Kardiologie, Pneumologie, und Angiologie (U.H., B.E.S., M.P.H.), Heinrich-Heine-Universität, Düsseldorf, Germany. Dr Manegold is now at the Bernhard-Nocht-Institut für Tropenmedizin, Hamburg, Germany.

Correspondence to Dr Christoph Manegold, Bernhard-Nocht-Institut für Tropenmedizin, Klinische Abteilung, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany. E-mail manegold{at}bni.uni-hamburg.de

Background—Restenosis is a common problem after all revascularization procedures in atherosclerotic coronary arteries. Reactivated human cytomegalovirus (CMV) has been detected in tissues of restenotic vascular lesions and was hypothesized to be a contributing pathogenic factor. Recent data suggest an association of restenosis after optimal coronary atherectomy with CMV serostatus, and a possible role of antiviral therapy was discussed. We therefore tested the hypothesis that prior CMV infection might be a risk factor for restenosis after conventional coronary balloon angioplasty (PTCA).

Methods and Results—We analyzed 92 consecutive patients who had been admitted for control angiography after previous PTCA within a mean interval of 6 months. Anti-CMV antibodies were measured as an indicator of prior CMV infection and latency. The coronary angiograms before PTCA, directly after, and 6 months later were analyzed quantitatively. Sixty-five percent of the patients were CMV-positive. Before PTCA, the degree (mean±SD) of stenosis was 69±10% in CMV-positive and 68±8.3% in CMV-negative subjects. PTCA resulted in a residual stenosis of 39% in both groups. After 6 months, the late losses of luminal diameter in the CMV-positive and -negative groups were 11±13% and 12±15%, respectively (P=0.658). In an ANCOVA with 25 potential risk factors for restenosis, CMV serostatus was not significantly associated with restenosis development.

Conclusions—Our data indicate that prior CMV infection, in contrast to optimal atherectomy, is not associated with chronic restenosis after conventional coronary balloon angioplasty. The results do not support a possible benefit from antiviral therapy.

Key Words: restenosis • viruses • angioplasty • atherosclerosis • angiography

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