title: Impact of residual plaque burden after balloon angioplasty in the MultiVitamins and Probucol (MVP) trial.
abstract: BACKGROUND
  It has been shown in the MultiVitamins and Probucol (MVP) trial that probucol reduces angiographic lumen loss by 68% after percutaneous transluminal coronary angioplasty (PTCA). Restenosis occurred in 40% of patients not treated with probucol and in 20% of those in the probucol alone group.
  
  
  OBJECTIVE
  To determine the morphological predictors of restenosis in patients treated with probucol.
  
  
  METHODS
  Beginning 30 days before angioplasty, 317 patients were randomly assigned to receive probucol, multivitamins, the combined treatment or placebo. Patients were then treated for six months after angioplasty. Intravascular ultrasound (IVUS) examination was performed immediately after angioplasty and at follow-up in 94 patients (108 segments). The angioplasty operator was blinded to the IVUS results. The cross-section selected for serial analysis was the one at the angioplasty site with the smallest lumen area at follow-up. Receiver operating characteristic curves were used to determine the performance of criteria to predict angiographic restenosis at follow-up.
  
  
  RESULTS
  In probucol-treated patients, the cross-sectional area (CSA) narrowing of 67.6% or less was the best IVUS predictor for the absence of restenosis (P=0.03). Diameter stenosis of 35% or less almost reached significance as a predictor in these patients (P=0.056). The restenosis rate when either of these predictors was met was less than 13%. Rates of repeat PTCA in patients treated with probucol were 9.7% when CSA narrowing was 67.6% or less on IVUS and 3.1% with a post-PTCA stenosis of 35% or less on quantitative coronary angiography (QCA). No predictor of the absence of restenosis in patients not treated with probucol was identified.
  
  
  CONCLUSIONS
  The presence after balloon angioplasty of a CSA narrowing of 67.6% or less on IVUS or a diameter stenosis of 35% or less on QCA is associated, in patients treated with probucol, with extremely low rates of coronary restenosis and repeat angioplasty.
authors.affiliation: Department of Medicine, Montreal Heart Institute, Montreal, Canada.  tardifjc@icm.umontreal.ca
authors.forename: J C
authors.initials: JC
authors.lastname: Tardif
authors.forename: G
authors.initials: G
authors.lastname: Côté
authors.forename: J
authors.initials: J
authors.lastname: Lespérance
authors.forename: G
authors.initials: G
authors.lastname: Gosselin
authors.forename: M
authors.initials: M
authors.lastname: Joyal
authors.forename: P
authors.initials: P
authors.lastname: de Guise
authors.forename: L
authors.initials: L
authors.lastname: Bilodeau
authors.forename: S
authors.initials: S
authors.lastname: Doucet
authors.forename: F
authors.initials: F
authors.lastname: Harel
authors.forename: A
authors.initials: A
authors.lastname: Couturier
authors.forename: R
authors.initials: R
authors.lastname: Gallo
authors.forename: J
authors.initials: J
authors.lastname: Grégoire
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D000924:Anticholesteremic Agents / Q000008:administration & dosage*; D000975:Antioxidants / Q000008:administration & dosage*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000517:prevention & control / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D011341:Probucol / Q000008:administration & dosage*; D012372:ROC Curve; D012008:Recurrence; D018084:Ultrasonography, Interventional; D014815:Vitamins / Q000008:administration & dosage*
chemical_list: D000924:Anticholesteremic Agents; D000975:Antioxidants; D014815:Vitamins; D011341:Probucol