Post Percutaneous Transluminal Coronary Angioplasty Research Articles

Thyroid Dysfunction and Dyslipidemia in Patients Suffering from Coronary Artery Disease

Background: Thyroid hormones are known to have effects on multiple systems, including the cardiovascular system. Hypothyroidism leads to hypercholesterolemia, hyperfibrinogenemia, hyperhomocysteinemia, platelet abnormalities, and systemic vasculitis, all of which can adversely affect the cardiovascular system. Objectives: The objective of this study was to evaluate the lipid abnormalities and thyroid function in cases suffering from coronary artery disease (CAD). Material and Methods: A case-control study was conducted involving 100 patients admitted to the Department of Cardiology in N.R.S Medical College, Kolkata, with CAD as the case and 100 age-matched healthy individuals as controls. Patients with post-percutaneous transluminal coronary angioplasty and post-coronary artery bypass graft were not included in the study. Patients taking amiodarone, lithium, or iodine-containing drugs and giving a history of thyroid disorder, renal disorder, or liver cirrhosis were excluded from the study. Blood glucose and thyroid hormones were estimated as per standard procedure. Results: Fasting plasma glucose, hemoglobin A1C, serum total cholesterol, very-low-density lipoprotein cholesterol, low-density lipoprotein cholesterol, free triiodothyronine levels, and high-density lipoprotein cholesterol were found to be significantly higher and lower, respectively, among cases. Conclusion: Sick euthyroid syndrome with low T3 has been reported as an important marker for the severity of CAD and has been reported to predict mortality in cardiac care unit (CCU) patients. Inclusion of thyroid profile during assessment of risk factors of CAD may be recommended.

Post Percutaneous Transluminal Coronary Angioplasty (PTCA) Coronary Aneurysm- A Case Report

Introduction Coronary aneurysm defined angiographically as luminal dilation 50% larger than that of the adjacent reference segment. (1) Drug-eluting stents (DES), which locally elute antiproliferative drugs, can dramatically inhibit neointimal growth. However, several pathological studies have indicated that DES may delay healing after vascular injury, and DES implantation may be theoretically associated with a risk of coronary artery aneurysm formation. Coronary aneurysms have been reported from 3 days to up to 4 years after DES implantation procedures, with varying clinical presentations. The incidence of coronary artery aneurysms after DES implantation is low within the first 9 months, with a reported incidence of 0.2% to 2.3%, a rate similar to that reported after bare-metal stent (BMS) implantation (0.3% to 3.9%) in the DES versus BMS randomized trials.(2) However, the true incidence of coronary aneurysms in an unselected patient population is still largely unknown. It can be congenital, or secondary to vasculitis (Kawasaki disease) or after percutaneous coronary intervention. Drug-eluting stents (DES), which locally elute antiproliferative drugs, can dramatically inhibit neointimal growth has become standard of care for routine coronary angioplasty. However, several pathological studies have indicated that DES may delay endothelial healing after vascular injury, and DES implantation may be theoretically associated with a risk of coronary artery aneurysm formation (3)

Comparative effectiveness and safety of prasugrel and ticagrelor in patients of acute coronary syndrome undergoing percutaneous transluminal coronary angioplasty: A propensity score-matched analysis

Evidence on comparative effectiveness and safety of prasugrel and ticagrelor post-percutaneous transluminal coronary angioplasty is scarce in Indian population. In a 1:1 propensity score-matched cohort with 71 individuals in each group, the incidence of a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or coronary revascularization was not significantly different in prasugrel and ticagrelor group (7.04% vs 9.86%; absolute difference, 2.8%; HR, 0.65; 95% CI, 0.21–2.1; p = 0.49). There was no significant difference in bleeding (5.63% vs 9.86%; absolute difference, −4.20%; 95% CI, −13.0%–4.5%) and dyspnea (7.04% vs 12.7%; absolute difference, −5.60%; 95% CI, −15.4%–4.1%).

ROLE OF SHORT SIX WEEKS HOME BASED AEROBIC EXERCISES IN PATIENTS WITH POST PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (PTCA)

To examine the cardiovascular adaptations and functional capacity (6 min walk test, rate of perceived exertion, resting heart rate, maximal heart rate, systolic and diastolic blood pressure, mean arterial blood pressure) by giving Aerobic Exercises in Post Percutaneous Transluminal Coronary Angioplasty patients. The need for the study is to know the efficiency of aerobic exercises in post percutaneous transluminal coronary angioplasty (PTCA). To evaluate whether the patient can perform the aerobic exercises with -out any difficulty. To evaluate the effects of aerobic exercises on an individual with post PTCA and lead a better life after post PTCA. Key Words: Percutaneous Transluminal Coronary Angioplasty (PTCA); Resting Heart Rate (RHR); Maximal Heart Rate (MHR); Blood Pressure (BP); Systolic Blood Pressure (SBP); Diastolic Blood Pressure (DBP); Mean Arterial Blood Pressure (MRBP) cardiovascular diseases (CVD); Coronary heart diseases (CHD).

Low Dose Combined Spinal-Epidural (CSE) Anaesthesia with Blocks for Management of A High-Risk Geriatric Patient with Dilated Cardiomyopathy Posted for TURBT

Introduction: Transurethral resection of bladder tumors (TURBT) is the first-line method and mainstay for endoscopic diagnosis, staging, and treatment of urinary bladder tumours. Hypotonic fluid absorption, electrolyte imbalance from irrigation, haemorrhage, and obturator jerk episodes are just a few of the procedure’s intrinsic risks. Cardiovascular issues were more likely to arise in elderly patients undergoing this surgery. A high risk of pulmonary oedema, arrhythmia, and bleeding problems exists in individuals with coronary artery disease (CAD), dilated cardiomyopathy (DCMP), multiple comorbidities, and anticoagulant medication. Case Presentation: Here, we provide a challenging situation of A 74-year-old man was scheduled to have TURBT (Transurethral Resection of Bladder Tissue) for a bladder mass with hematuria and many comorbidities, including Hypertension (HTN), Chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), post percutaneous transluminal coronary angioplasty (PTCA), cerebrovascular accident (CVA), dilated cardiomyopathy (DCMP), ejection fraction (EF) 25%, and Severe MR necessitating obturator nerve block (ONB), spinal anaesthesia (SA), and epidural anaesthesia (EA) for perioperative and postoperative anaesthetic as well as analgesia, which was effectively handled without any difficulties. Conclusion: Elderly patient with ischemic cardiomyopathy are at higher risk of major cardiovascular events perioperatively. Low dose spinal anaesthesia combined with epidural anaesthesia provides better hemodynamic stability, prevents myocardial depression, provide perioperative analgesia and early ambulation. Keywords: Obturator nerve block, Spinal anaesthesia, General anaesthesia practice, Transurethral Resection of Bladder Tissue (TURBT), Cerebrovascular accident (CVA), Chronic obstructive pulmonary disease (COPD)

Rosuvastatin-Induced Reversible Rhabdomyolysis

We report a case of rhabdomyolysis (RM) in a postpercutaneous transluminal coronary angioplasty patient caused by a high dose of rosuvastatin. She was admitted to the hospital with complaints of muscle weakness, myalgia, and passing red-colored urine for the last 7 days. Routine blood investigations showed serum creatinine 1.51 mg/dl, creatinine phosphokinase (CPK) 31,000 U/L, and urine myoglobin 934 ng/ml. The patient was diagnosed with rosuvastatin-induced RM. Rosuvastatin was stopped on the day of admission, and intravenous fluids were started with strict monitoring of clinical and biochemical profile. Consequently, her CPK and urine myoglobin started decreasing and her symptoms improved. The patient was discharged from the hospital on the 10th day without a statin. Rosuvastatin-induced RM is discussed as a potentially preventable life-threatening side effect.

A Rare Presentation of Coronary Aneurysm following Bare-metal Stent

We present a case of post-percutaneous transluminal coronary angioplasty with a bare-metal stent to the right coronary artery (RCA). He presented with acute ST-elevation inferior wall myocardial infarction. Coronary angiography showed an aneurysm of proximal RCA extending from the proximal end of the stent to the distal end. There was a 90% discrete lesion beyond the stent with TIMI III flow. The development of coronary artery aneurysms (CAAs) was reported even before the era of stents. CAA can develop after plain balloon angioplasty, after directional coronary atherectomy, and after bare-metal and drug-eluting stents also but not after coronary angiography. Kachru et al. reported an incidence of 0.2% (4 of 2408) per DES without routine angiographic follow-up and Rha et al. reported an incidence of 1.7% (five out of 296) per patient at 6-month routine angiographic follow-up. CAA is an uncommon and often accidental finding, we report a case of CAA which presented as acute myocardial infarction mimicking stent thrombosis.

ANTICOAGULANT DRUG INDUCED SUPRA THERAPEUTIC INR AND ITS MANAGEMENT

This paper has the management of Drug Induced Supra therapeutic INR and a case presentation of 33-year-old Male patient who was on oral anticoagulant (Vitamin K antagonist-VKA) and antiplatelet therapy presented with supra-therapeutic international normalized ratio (INR) with history of Single episode of blood stained Sputum. The patient is known case of posterior circulation stroke with left ventricular clot, Cortical venous sinus thrombosis with left parietal hematoma and secondary seizure, ischemic heart disease (IHD) status post Percutaneous Transluminal Coronary Angioplasty (PTCA) to LAD with left ventricular ejection fraction (LVEF) - 30% and hyper-homocysteinemia. The patient presented with history of single episode of blood stain sputum and with no other complaints. His routine blood investigation revealed INR of 9.50 hence the patient was admitted and treated accordingly. Patients INR returned to normal after appropriate medical management. Patient was discharged with a titrated dose, advised on treatment, education and adherence counselling.

The effect of mobile application-based technology use on medication compliance and modification of risk factors in post PTCA cohort of patients

Mobile application-based technology was used to study medication compliance and influence on cardiovascular lifestyle in ischemic heart disease (IHD) patients who undergo percutaneous transluminal coronary angioplasty (PTCA). The Mobile-app was made available at Google play store; the app was downloaded and instructions to use were thought to patients by the research team during hospitalization in the study group. A total of two hundred patients with ischemic heart disease who underwent PTCA were enrolled into the study. The control group had telephonic follow up at periodic interval. Both groups had clinical follow ups at appropriate time intervals. Higher medication compliance, smaller number of adverse events and regular follow ups were significantly more in mobile-app group than in control group.

One year follow-up of post percutaneous transluminal coronary angioplasty in patients with coronary heart disease

Background: Globally, the Cardiovascular Diseases (CVDs) has become the number one cause of death. Antithrombotic therapy along with Percutaneous Coronary Intervention (PCI) is the most common preferred approach to improve clinical outcomes. Aims: To know the clinical end points of Myocardial infarction like unstable angina, congestive cardiac failure and death in post Percutaneous Transluminal Coronary Angioplasty (PTCA). Methodology: This study was designed as prospective observational study, carried out on myocardial infarction patients who have underwent PTCA surgery. These patients were subjected to detailed clinical examination with observation on signs of unstable angina, reinfarction and mortality. All the patients were called for follow up at 3, 6, and 12 months and they underwent clinical examination, ECG and 2D echo. The collected data was entered into excel chart and analysed using SPSS V.23. The Chi-square test was used and p-value less than 0.05 was considered as statistically significant. Results: A total of 240 patients were included with mean age of 56.7 ± 9.6 years with a range and gender ratio of 3.1:1. Around half of the patients had anterior wall Myocardial Infarction (MI), 31.2% had inferior wall MI and 13.8% had lateral wall MI. Nine (3.8%) patients had global ischemia. All patients had undergone PTCA surgery. At 12 months follow-up, 8.33% had angina, 5.8% had reinfarction and 3.3% died during the study period. Conclusion: Angioplasty in myocardial infarction cases is able to achieve good long-term results.

A Study on the Impact of the Novel Biochemical Parameter-Calcium Score in Preventing the Progression of the Cardiovascular Diseases to Invasive Interventions.

Cardiovascular diseases is increasing its pace day by day. Though the traditional biomarkers are made available the novel biomarkers are being incorporated to predict the risk of cardiovascular diseases for earlier detection. The present study aimed to investigate the impact of calcium score level the novel biochemical parameter in preventing the progression of the cardiovascular patients to PTCA (percutaneous transluminal coronary angioplasty) and CABG (coronary artery bypass grafting). Four hundred cardiovascular patients irrespective of sex were randomly selected from Visakhapatnam district Andhrapradesh. Information of subjects was collected using an interview schedule. Data collected were consolidated and tabulated. From this group a sub sample of 50 patients was selected and grouped as primordial, secondary and post PTCA. The subjects were then analyzed for their biochemical parameters before and after intervention. Statistical analysis was done and interpreted. An extensive evidence of calcium score was shown among 61.2% of the cardiovascular patients, a minimum evidence of 22.2% and moderate evidence of about 16.5%. The paired sample t-test is employed to observe any statistical significant difference between the before and after treatment effects. The analysis for the calcium score level was found to be significantly lower (mean difference=424.0134; t=13.297; df=49; p=0.01) in post intervention (mean=88.3766±88.40) than pre-intervention (512.39±260.79812). The present study identified calcium score the novel biochemical parameter as a key preventive measure among the usual biochemical management conducted by the clinicians to diagnosis and confirm the progression of the disease.

Diffuse Alveolar Hemorrhage: A Very Rare but Catastrophic Complication After Percutaneous Transluminal Coronary Angioplasty

In this write-up, we report a case of persistent hemoptysis after percutaneous transluminal coronary angioplasty (PTCA), which was diagnosed as diffuse alveolar hemorrhage (DAH). DAH is a life-threatening medical emergency that can be caused by numerous disorders and it, further, presents with hemoptysis, anemia, and diffuse alveolar infiltrates. Early diagnosis is usually required for this noninfectious cause in post PTCA patient, as it is very rare complication.

Comparison of Clinical Effectiveness of Ticagrelor and Clopidogrel in Post Percutaneous Transluminal Coronary Angioplasty (PTCA) Patients Approaching A Tertiary Care Hospital in South India

Introduction: Dual antiplatelet therapy is recommended for prevention of secondary cardiovascular events in acute coronary syndrome patients who undergo percutaneous transluminal coronary angioplasty (PTCA). This therapy includes aspirin with either of a P 2 Y 12 platelet receptor inhibitor like clopidogrel or ticagrelor. Methodology: A retrospective cohort study with 1 year follow up which compared clopidogrel and ticagrelor for determining clinical effectiveness in post PTCA patients through the incidence of primary and secondary end points. Primary end points included cardiovascular death, Myocardial Infarction (MI), unstable angina, secondary revascularization and Congestive Heart Failure (CHF). Secondary end points were bleeding and dyspnea. Results: Age, gender, cardiovascular risk factors, concomitant medications administered and angioplasty specifications like the number of stents, type of stents and approach route were in comparable between clopidogrel and ticagrelor groups. The primary end points, a composite of cardiovascular death, unstable angina and secondary revascularization occurred more in the clopidogrel group (9%) than in ticagrelor group (5%) in 12 months follow up period. The secondary end points, a composite of bleeding and dyspnea were observed more in the ticagrelor group (11%) compared to clopidogrel group (5%). Conclusion: The use of ticagrelor prevents the incidence of secondary cardiovascular events in post PTCA patients to a greater degree than clopidogrel in comparable risk groups. Our observation revealed that ticagrelor was found to be better drug than clopidogrel as a prophylactic antiplatelet drug though there was increased incidence of dyspnea and bleeding in ticagrelor group. Key words: Antiplatelets, Ticagrelor, Clopidogrel.

Outcomes with Longterm Dual Antiplatelet Therapy After Coronary Angioplasty

AbstractIntroduction: The optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation is an important, unanswered question. This study was designed to evaluate the association of varying durations of DAPT on clinical outcomes after DES implantation for the treatment of coronary artery disease.Methods: Registry is maintained about the follow up of patients on DAPT therapy post percutaneous transluminal coronary angioplasty (PTCA) and the complications are noted in the follow up period between December 2015and May 2016 in NIMS hospital. Results were analyzed using appropriate Statistical tests.Results: The number of evaluated patients was 127 with median age of 62 years. There were 27 females in them. Mean DAPT score was 1.68, with majority in the score range of one or two. Mean follow up period was 5.92 years (1 to 15 years). Among 127patients only 4 patients had complications, 3 of them had chronic stable angina and one had ischaemic stroke with no bleeding complication.Conclusion: DAPT beyond one year has benefits in terms of low associated complications and low incidence of coronary events.

Dyspnea in Post Percutaneous Transluminal Coronary Angioplasty (PTCA) Patients on Dual Antiplatelets in a Tertiary Care Hospital in South India

Background: For post Percutaneous Transluminal Coronary Angioplasty for Acute Coronary Syndromes, Dual Antiplatelet Therapy with Aspirin and a P2Y12 receptor inhibitor like Ticagrelor or Clopidogrel is required minimum for a period of 12 months. There are few studies which have shown the incidence of dyspnea in patients receiving antiplatelet therapy. Methods: In this retrospective, single centre, cohort study, patients who underwent PTCA and were on dual antiplatelets were randomly selected from the clopidogrel and ticagrelor group between July 2013 and June 2014. Patient’s relevant data were collected from electronic medical records and cross checked with manually maintained medical records wherever necessary. The study endpoint was incidence of dyspnoea within a follow up period of 9 months. Results: Among the 100 patients started on dual antiplatelet therapy with aspirin and ticagrelor, dyspnea occurred in 10% patients. Ticagrelor was substituted with clopidogrel in 60% cases. In 100 patients on clopidogrel, dyspnea occurred in 5% of patients, but clopidogrel was continued in all cases. Onset of dyspnea in patients on Ticagrelor occurred in 50% of patients in the first month of follow up, 10% cases at 3 months, 30% cases at 6 months and 10% cases at 9 months. But in clopidogrel group dyspnea occurred in 40% cases at 6 months follow up and 60% cases at 9 months. The p value on comparison of dyspnoea among the two groups was found to be 0.283, which was not statistically significant probably due to less sample population. Conclusion: Risk for dyspnoea induced by Ticagrelor was found to be higher than with Clopidogrel in the same ethnic groups when used as dual antiplatelet along with Aspirin. So it may not be a class effect or due to P2Y12 receptor inhibitory action alone.

English

Chronic necrotizing pulmonary aspergillosis or semi-invasive pulmonary aspergillosis is one of the forms of pulmonary aspergillosis typically found in mildly immunocompromised patients. It is an indolent, cavitary and infectious process of the lung parenchyma secondary to local invasion by aspergillus species. We report a case of a male patient aged 55 years with complaints of chronic productive cough with blood tinged sputum, orthopnea, acute episode of hemoptysis and post percutaneous transluminal coronary angioplasty status 6 weeks back. X-ray and computed tomography of the chest revealed consolidation with interposed cavitation in the right upper lobe and pleural thickening. Computed tomography guided fine needle aspiration cytology smears showed aspergillus hyphae with abundant necrotic material and inflammatory cells. Fungal stains were positive for aspergillus. Based on the clinical, radiological and cytological findings, the patient was diagnosed with chronic necrotizing pulmonary aspergillosis and treated successfully with oral itraconazole. In view of difficult diagnosis of chronic necrotizing pulmonary aspergillosis, fine needle aspiration cytology plays important role when biopsy is not possible, contributing to early treatment with systemic antifungal therapy and preventing its morbidity and mortality. Surgery plays a small role in the treatment because of poor overall lung function in many patients.

English

Chronic necrotizing pulmonary aspergillosis or semi-invasive pulmonary aspergillosis is one of the forms of pulmonary aspergillosis typically found in mildly immunocompromised patients. It is an indolent, cavitary and infectious process of the lung parenchyma secondary to local invasion by aspergillus species. We report a case of a male patient aged 55 years with complaints of chronic productive cough with blood tinged sputum, orthopnea, acute episode of hemoptysis and post percutaneous transluminal coronary angioplasty status 6 weeks back. X-ray and computed tomography of the chest revealed consolidation with interposed cavitation in the right upper lobe and pleural thickening. Computed tomography guided fine needle aspiration cytology smears showed aspergillus hyphae with abundant necrotic material and inflammatory cells. Fungal stains were positive for aspergillus. Based on the clinical, radiological and cytological findings, the patient was diagnosed with chronic necrotizing pulmonary aspergillosis and treated successfully with oral itraconazole. In view of difficult diagnosis of chronic necrotizing pulmonary aspergillosis, fine needle aspiration cytology plays important role when biopsy is not possible, contributing to early treatment with systemic antifungal therapy and preventing its morbidity and mortality. Surgery plays a small role in the treatment because of poor overall lung function in many patients.

Secondary prevention and learning needs post percutaneous coronary intervention (PCI): perspectives of both patients and nurses

To evaluate the learning needs of patients post percutaneous coronary intervention from the perspective of both patients' and cardiac nurses'. Increasing numbers of patients with cardiovascular disease are managed using postpercutaneous transluminal coronary angioplasty. This paper presents findings of a study which explored the cardiac learning needs of these patients. Descriptive survey from one cardiac unit where approximately 30 post percutaneous coronary intervention were performed per month. Self-report data were provided by patients using an adaptation of the Nursing Information and Support scale for health-related quality of life informational needs. This scale includes physical, psychosocial, emotional and disease-specific dimensions. The questionnaire was also provided to cardiac nurses. Statistical tests applied were Spearman's Correlation and the Mann-Whitney U test. Patients (n = 33) and nurses (n = 13) completed the questionnaire. Disease-specific items, physical action, psychosocial and emotional information were the categories that patients found most important. Cardiac nurses perceived physical action as least important and focused more on psychosocial and emotional issues. Individual items revealed the patients particularly valued their interaction with the nurses. Patients appear to be more concerned with their immediate state and disease rather than their psychosocial or emotional state. Mean rankings within scales demonstrate the value patients place on the nurse-patient relationship and the time needed for this. Findings may be helpful to nurses who wish to addresses secondary prevention issues with patients' post percutaneous coronary intervention who experience short hospital stays.

Exercise Electrocardiogram Testing

Exercise testing remains the most widely accessible and relatively inexpensive method for initial evaluation of suspected coronary disease and for evaluation of its severity.1–3 Clinical usefulness has been limited, however, by poor sensitivity of standard ST-segment depression criteria for assessment of anatomic and functional coronary disease severity and for prediction of risk.1,2,4–6 Recent data make it clear that symptomatic obstructive plaques that typically result in exercise-mediated ischemia may be less relevant to infarction and sudden death than less obstructive unstable plaques.7 These limitations mandate a rethinking of the exercise ECG along 2 distinct lines: First, is it possible to improve the diagnostic value of the exercise ECG? Second, separate from its ability to diagnose obstructive coronary artery lesions, can the exercise test be used as a prognostic tool that can encourage effective prevention of premature deaths or coronary events? Both goals take us beyond the ST segment. Reversible ST-segment depression is the characteristic finding associated with exercise-induced, demand-driven ischemia in patients with significant coronary obstruction but no flow limitation at rest. This process differs from the flow-limited acute coronary syndromes because exercise-related ischemia is generally limited to the subendocardium and is proportional to increases in myocardial oxygen demand. Ventricular waveforms of the ECG can be related to the net uncanceled transmural gradients between endocardial and epicardial myocardium, as extrapolated from the work of Holland and Brooks, among others.8–10 Accordingly, isoelectric TQ and ST segments in normal and in nonischemic patients can be related to comparable resting membrane and action potential plateau voltages in endocardial and epicardial action potentials. During exercise, progressive ischemia results in changing endocardial action potentials during both diastole and systole. Less negative endocardial cell resting membrane potential leads to current flow across the ischemic boundary during diastole, leading to elevation of the TQ …

Family history, diabetes and extension of coronary atherosclerosis are strong predictors of adverse events after PTCA: A one-year follow-up study

In this study we addressed some open questions in patients with coronary artery disease (CAD). First, we analysed which of the traditional risk factors was associated with the spreading of coronary stenosis and second, we aimed to identify if any variable was predictive of post-percutaneous transluminal coronary angioplasty (PTCA) clinical events. We collected a consecutive series of patients with CAD (n=301) and in the subgroup of patients undergoing PTCA (n=135) we performed a prospective one-year follow-up study recording cardiovascular morbidity and total mortality. According to the extension of coronary atherosclerosis, we found a significant relationship with the prevalence of diabetes in men and with plasma HDL-cholesterol concentrations in women. The follow-up was completed in 95% of patients; we did not document any death whereas clinical events were registered in 16% of patients. At univariate analysis, we found that patients with clinical events had a higher prevalence of family history of CAD (43% vs 14%, p<0.005), diabetes (52% vs 21%, p<0.005) and multivessel disease (52% vs 35%, p<0.05). Multivariate analysis (logistic regression) confirmed that family history of CAD (OR 4.6, 95% CI 1.7-12.8, p<0.005), diabetes (OR 4.0, 95% CI 1.5-10.6, p<0.01) and multivessel disease (OR 2.8, 95% CI 1.1-7.4, p<0.05) were the only variables predictive of clinical events. In this study, factors associated with the spreading of coronary stenosis were different according to the gender. Moreover, the presence of diabetes and multivessel disease had a negative impact on the long-term prognosis of patients undergoing PTCA. In addition, the family history of CAD represented in our study a strong predictor of clinical events. We suggest that in the management of post-PTCA patients, the role of individual baseline clinical characteristics must be taken into account and that subjects with a family history of premature CAD, diabetes and a wide extension of coronary disease represent those with the highest risk.