Early luminal deterioration following successful percutaneous transluminal coronary angioplasty. Frequency, prediction and clinical implications.
In order to develop a predictive model for the risk of early lesion deterioration following successful coronary balloon angioplasty (PTCA) based on clinical, pre-angioplasty and procedural characteristics, 154 lesions in 146 consecutive patients undergoing successful PTCA for stable/unstable angina were examined by quantitative coronary analysis immediately after and within 24 h of angioplasty. An angiographic complication score was used prospectively, classifying the lesion morphology post-PTCA into class 0: no complication and classes 1 to 3, according to purely descriptive morphological characteristics. Significant deterioration, defined as a decrease in minimal luminal diameter of more than 2 standard deviations of duplicate measurements post-intervention (0.54 mm; 95% confidence limit for variability using quantitative angiography) was found in 28 lesions (18%), and a total reocclusion in seven lesions (5%). The angiographic complication score (P = 0.019), prior to myocardial infarction (P = 0.076), minimal luminal diameter immediately post-intervention (P = 0.021) and gain of PTCA (P = 0.042) were found to be independently predictive of early lesion deterioration by multiple logistic regression analysis. Identification of these factors and their associated risk should improve success, and understanding of the early vascular response following coronary angioplasty. Moreover, these results have implications for clinical restenosis studies, particularly those assessing the effect of pharmacological interventions on late restenosis rates.
Preisack
M B
MB
Department of Cardiology, Tübingen University, Germany.
Athanasiadis
A
A
Voelker
W
W
Karsch
K R
KR
D015906:Angioplasty, Balloon, Coronary; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D017023:Coronary Angiography / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D012008:Recurrence; D012044:Regression Analysis; D012307:Risk Factors; D013997:Time Factors