Relation of stenosis resolution pressure to long-term clinical outcome after successful percutaneous transluminal coronary angioplasty

Abstract

Variables associated with a poor long-term prognosis after successful percutaneous transluminal coronary angioplasty (PTCA) include a short duration of symptoms before PTCA, unstable angina and the presence of thrombus at the PTCA site. These imply a component of transient or dynamic obstruction as opposed to a pure fixed obstruction. It is postulated that resolution pressure (i.e., the pressure at which complete balloon inflation occurs) may also correlate with prognosis after successful PTCA. In 173 consecutive patients undergoing successful, elective, single-lesion PTCA, 48 (28%) were found to have narrowings that resolved at ≤2 atm (group 1) and 125 (72%) were found to have narrowings resolved at >2 atm (group 2). There were no significant differences in baseline, anatomic or procedural variables between the 2 groups, except that angiographic coronary dissection occurred in 17% of group 1 patients versus 40% of group 2 patients (p < 0.007). During a mean follow-up of 12.0 ± 6.1 months, the incidence of cardiac events (repeat PTCA, coronary artery bypass grafting or myocardial infarction) was 29% in group 1 versus 15% in group 2 (p < 0.05). The overall incidence of angina was similar between the groups (25 vs 28%), but Canadian Cardiovascular Association class 4 angina occurred significantly more frequently in group 1 than group 2 (21 vs 8%) (p < 0.04). These data suggest that a low resolution pressure is associated with a higher incidence of unstable angina and recurrent cardiac events during follow-up than higher resolution pressures.