Predictive factors of restenosis after multivessel percutaneous transluminal coronary angioplasty

Abstract

To evaluate the rate and predictive factors of restenosis after multivessel percutaneous transluminal coronary angioplasty (PTCA), 122 consecutive patients with multivessel PTCA performed in the same setting were included in a prospective study. Systematic angiographic control at 6 months was performed in 112 patients (92%). Restenosis (increase >20% and stenosis >50%) was found in 62 patients (55%) and 82 of 254 segments (32%) were dilated. Statistical analysis identified the number of successfully dilated segments as the only predictor of restenosis by patient (2.4 ± 0.7 vs 2.0 ± 0.7; p <0.03), and the greater degree of residual stenosis as the only predictor of restenosis by lesion (30 ± 14% vs 23 ± 12%; p <0.005). Twenty-two of 62 restenosed patients (35%) were asymptomatic (group 1). Baseline clinical and angiographic characteristics of these patients were similar to those with symptomatic restenosis (n = 40; group 2) and without restenosis (n = 50; group 3). Repeat revascularization for restenosis was used only in symptomatic patients (re-PTCA in 36; bypass surgery in 4). After a mean follow-up of 75 ± 24 months, clinical status, and rates of cardiac death and myocardial infarction were similar In the 3 groups. Medical care was similar in groups 1 and 3, and higher in group 2. However, the rate of repeat revascularization for progression of disease was similar in the 3 groups (29%). In conclusion, restenosis is a frequent event after multivessel PTCA and is strongly related to the number of successfully dilated segments. Patients with asymptomatic restenosis have the same long-term medical care and prognosis as do those without restenosis. Therefore, 6-month angiographic control after multivessel PTCA increases medical consumption without adding any benefit in management of asymptomatic patients.