Successful Percutaneous Transluminal Coronary Angioplasty Research Articles

Assessment of Peri-Procedural Myocardial Injury by High-Sensitivity Troponin-I Levels after Successful Elective Percutaneous Transluminal Coronary Angioplasty

Assessment of Peri-Procedural Myocardial Injury by High-Sensitivity Troponin-I Levels after Successful Elective Percutaneous Transluminal Coronary Angioplasty

Impact of Coronary Chronic Total Occlusion on Long-term Clinical Outcome in Patients with Unprotected Left Main Disease Undergoing Percutaneous Coronary Intervention

Objectives: Reported data regarding the prevalence, prognostic impact, and safety and efficacy of revascularization of coronary chronic total occlusion (CTO) in patients with left main coronary artery (LMCA) disease who undergo percutaneous coronary intervention (PCI) are scarce. The aim of the present study was to compare clinical outcomes among patients with LMCA disease undergoing PCI. Outcomes were compared between those with and without coronary CTO and between those with CTO who had successful and unsuccessful CTO recanalization procedures. Methods: All consecutive patients with significant LMCA disease (>50% stenosis at coronary angiography) who underwent PCI between July 2014 and December 2018 were retrospectively included in our study. The primary endpoint of the study was long-term mortality. Secondary endpoints included the incidence of myocardial infarction, repeat percutaneous or surgical revascularization, stroke, and stent thrombosis. Results: Between July 2014 and December 2018, 578 patients underwent PCI for LMCA disease at Pederzoli Hospital and University of Turin were enrolled. They were divided into 3 groups: group A: 374 (65%) patients without CTO, group B: 108 (19%) patients with untreated or unsuccessfully treated CTO, and group C: 96 (17%) patients with successfully treated CTO. At a median follow-up of (1090 ± 279) days, there were no statistically significant differences between the groups in terms of the primary and secondary endpoints. However, there was a trend towards higher mortality in patients with untreated or unsuccessfully treated CTO (13% vs. 19% vs. 14% in groups A, B, and C, respectively; P = 0.12). The primary and secondary endpoints were further analyzed based on the presence or absence of myocardial viability: subgroup C1: 54 (56%) patients with successful percutaneous transluminal coronary angioplasty (PTCA) having viability, and subgroup C2: 42 (44%) patients with successful PTCA not having viability. There was a trend toward a statistically significant higher rate of death among patients in group B, who underwent unsuccessful recanalization with viable myocardium (19% vs. 9% vs. 19% in groups B, C1, and C2, respectively, P = 0.05). On multivariable analysis, the propensity for successful revascularization of CTO was associated with a reduced risk of death (P = 0.01; odds ratio, 0.75; 95% confidence interval: 0.62–0.87). Conclusions: Among patients with LMCA disease undergoing PCI, CTO represents a common finding associated with worse prognosis. Successful revascularization of CTO in patients with viable myocardium appears to significantly improve prognosis.

Effect of Cardiac Rehabilitaion in Percutaneous Transluminal Coronary Angioplasty (PTCA)

Introduction: Percutaneous transluminal coronary angioplasty (PTCA) also called percutaneous coronaryintervention (PCI) is a minimally invasive procedure to open blocked or stenosed coronary arteries allowingunobstructed blood flow to the myocardium. Cardiac rehabilitation is important role for more successful PTCA.To increase cardiac efficiency, increase exercise tolerance or endurance and to get the effective and better results.Case presentation: 45 years male admitted in emergency department with chest pain during gym workout.Blood reports, ECG, ECHO, and angiography done in investigation. In angiography RCA 99% stenosis and in D1ostial 60% stenosis. PTCA procedure done with DES to RCA. Twelve days after surgery patient came for cardiacrehabilitation in physiotherapy department.Management and Outcome: warm-up, aerobic period, and cool-down, abdominal exercise, strengthening exerciseincluded in cardiac rehabilitation. Pulse rate, blood pressure, respiratory rate, Spo2, Rate of perceived exertionscale and 6-min walk test, distance, vo2 max calculated as an outcome.Discussion: Cardiac Rehabilitation is most important for faster recovery as well as better efficiency for cardiacendurance. Maximum oxygen uptake increased after cardiac rehabilitation protocol.Conclusion: Cardiac Rehabilitation is helpful for more successful PTCA.

Coronary collaterals provide more than half of normal perfusion in patients with coronary artery disease - quantification by myocardial perfusion SPECT during elective balloon occlusion

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND The coronary collateral circulation is a preformed network of anastomotic connections acting as a "natural bypass" mechanism. Whilst the prevalence of collaterals varies between species, approximately 25% of patients have angiographically visible robust collaterals at the time of ST elevation myocardial infarction. While the presence of collaterals is associated with improved outcomes, the magnitude of myocardial perfusion which can be provided by the collateral circulation remains uncertain. PURPOSE The aim was to quantify collateral myocardial perfusion during experimental coronary balloon occlusion in patients with CAD. METHODS The study was approved by the local investigational review board, and all patients provided informed consent. Patients without prior infarction, bypass surgery, or angiographically visible collaterals undergoing elective percutaneous transluminal coronary angioplasty (PTCA) to a single epicardial vessel, underwent two scans with 99mTc-sestamibi myocardial perfusion single-photon emission computed tomography (SPECT). All subjects underwent at least three minutes of angiographically verified complete balloon occlusion, at which time an intravenous injection of the radiotracer was administered, followed by SPECT imaging. A second radiotracer injection followed by SPECT imaging was performed 24 hours after PTCA. RESULTS The study included 21 patients (median [interquartile range] age 70 [56-74] years, 52% male). The degree of diameter stenosis of treated vessels ranged from 60-99%, with successful PTCA performed with a mean 5-minute balloon occlusion time, resulting in ≤20% residual stenosis in all cases. The vessels undergoing PTCA were 6 in the LAD, 5 in the LCx, and 10 in the RCA. For the cohort, the size of the perfusion defect was 16 [8-30]% of the LV and the collateral perfusion at rest within the perfusion defect was 64 [58-68]% of normal perfusion within that region. Collateral perfusion was negatively correlated with perfusion defect size (R2 = 0.85, p < 0.001), but did not differ by sex (p = 0.27) or age (p = 0.58). CONCLUSIONS: This is the first study to describe the magnitude of microvascular collateral perfusion in CAD. On average, despite coronary occlusion and an absence of angiographically visible collateral vessels, collaterals provide approximately 60% of the perfusion that reaches the jeopardized myocardium during coronary occlusion. This magnitude of collateral perfusion is much higher than previously speculated. A previous study using microspheres in dogs found that collateral perfusion in the setting of an occluded vessel was 6% of normal. By comparison, the current study found ten times greater collateral perfusion in patients with CAD. Abstract Figure. Collateral perfusion during occlusion.

Impact of Elective Percutaneous Transluminal Coronary Angioplasty (PTCA) on Heart Rate Variability in Patients with Coronary Artery Disease

Coronary artery disease (CAD) is a major public health problem in India and is one of the leading causes of mortality and morbidity. Impairment of heart rate variability (HRV) has been observed in patients with CAD. Percutaneous transluminal coronary angioplasty (PTCA) is one of the common modalities of treatment of CAD. In this study we have studied the effect of successful elective PTCA on HRV parameters in patients with CAD. Material and Method: HRV parameters in both time and frequency domain were studied in 30 male patients before PTCA, one day and three day after PTCA. Results: - The time and frequency domain parameters between pre PTCA and 1st day post PTCA were not found to be statistically significant. Changes in the time domain parameter rMSSD and SDNN was statistically significant between pre and 3rd day post PTCA but no significant difference was observed in pNN50. A significant decrease in LF n.u and increase in HF n.u was observed between pre and 3rd day post PTCA. Conclusion: Revascularization with PTCA results in improvement of the autonomic tone. Improved autonomic modulation is seen as early as 3rd day post PTCA. It indicates that restoring the blood flow reverses to some extent the autonomic modulatory effect of coronary artery disease.

Clinical profile and outcomes of patients presenting with acute coronary syndrome in a tertiary care hospital

Objective: This article aimed to study the clinical profile and outcomes of patients presenting with acute coronary syndrome at a tertiary care hospital and to draw conclusions from the above data with regard to characteristics of Indian patients presenting with acute coronary syndrome. Materials and Methods: This cross-sectional study was carried out in one of the teaching medical college hospitals. All patients presenting to casualty with an acute coronary syndrome were admitted to the Coronary Care Unit. Standard history was taken, data were entered into a pro forma sheet, and relevant investigations were performed. Patients with ST-segment elevation myocardial infarction were thrombolysed, taken up for percutaneous transluminal coronary angioplasty (PTCA), or managed conservatively. Prompt medical treatment was started in all cases. The hospital course of the patients including complications, if any, was documented. Results and Conclusion: A total of 100 patients presenting with the acute coronary syndrome were studied. The majority of the patients were found to be male (77%). Hypertension was the most common risk factor followed by smoking, diabetes mellitus, and dyslipidemia. Of all patients, 63% presented with myocardial infarction. Serious complications occurred in 23% patients. The mean age of all patients was 55.5 ± 12.1 years. The age of presentation of females was on average a decade more than that of males. A small but significant percentage (11%) included premature patients younger than 40 years. Most of the patients presented between 1 and 6h of symptom onset. Of all patients, 33% underwent successful PTCA and were discharged on appropriate medication; moreover, 25% were advised PTCA but did not undergo due to various reasons. These were then managed medically. Of all patients, 15% were advised coronary artery bypass grafting and 24% were put on aggressive medical management. A majority of patients presented with single-vessel coronary artery disease (44%) and 3% died during the index hospitalization.

ACE insertion/deletion polymorphism and restenosis events after coronary stent placement in East Azerbaijan Province of Iran

Renin-angiotensin system is thought to play a role in coronary thrombosis and restenosis. Plasma angiotensin I-converting enzyme (ACE) activity is associated with an insertion/deletion polymorphism in the gene coding for ACE. The association among restenosis within coronary stents, the D/I polymorphism is analyzed in the present study. We are selected 50 patients who had undergone successful percutaneous transluminal coronary angioplasty, and angiography during 1 year after it for some reason. The I/D alleles were identified on the basis of polymerase chain reaction (PCR) amplification of the respective fragments from intron 16 of ACE gene. The differences between groups were tested by Chi-square test or Fisher exact test. Result from chi-square test and Fisher exact test shows the lack of differences between two groups with respect to sex, age, diabetes, hypertension, cholesterol, hyperlipidemia, stent type, length of stented segment, stent diameter and target vessel. In the second set of analysis, the relationship between genotypes and the outcome variable was tested. These analyses indicated that there were no statistically significant differences the three groups (χ2 (2) = 1.40, p=0 .47). The ACE D/D genotype or D allele does not influence the clinical and angiographic outcome of patients undergoing coronary stent placement. These data suggest that routine determination of the ACE genotype may not help identify patients who are at a higher risk of thrombotic and restenosis events after coronary stent placement.

Primary percutaneous coronary intervention for acute myocardial infarction in a patient with situs inversus dextrocardia

Situs inversus with dextrocardia is a rare congenital anomaly of development characterized by a mirror-image position of the heart and abdominal viscera. It occurs rarely in the general population, with an estimated incidence of 1:8000 to 1:10,000. Very few case reports exist of successful primary percutaneous transluminal coronary angioplasty (PTCA) and stenting in such patients. Here we report a case with dextrocardia and coronary artery disease (CAD) who underwent Primary PTCA and successful stenting of the culprit lesion.

Giant external iliac artery pseudoaneurysm following percutaneous coronary intervention: a rare case

Corresponding author: Suleyman Surer, M.D. Bursa Yuksek Ihtisas Egitim ve Arastirma Hastanesi Kalp ve Damar Cerrahisi Klinigi, 16330 Yildirim, Bursa, Turkey. Tel: +90 505 494 08 28 e-mail: drsuleyman1@hotmail.com Invasive cardiac interventions have an important role in development of lower extremity arterial pseudoaneurysms. A 27-year-old male patient presented with the complaint of difficulty in walking following the discharge from the hospital after a successful emergent percutaneous transluminal coronary angioplasty and stent implantation for acute myocardial infarction in a cardiology clinic. Arterial Doppler ultrasonography showed a 90 mm of pseudoaneurysm in the right external iliac artery. Closure of aneurysm by compression and thrombin injection under ultrasonographic guidance was planned, but failed. Aorto-femoral bypass was performed eventually.

Successful percutaneous transluminal coronary angioplasty for acute myocardial infarction in a 12-year-old boy with fibromuscular dysplasia: a case report

Acute myocardial infarction is rarely reported in children. Most of the cases are secondary to congenital anomalies or Kawasaki disease. Coronary artery total occlusion caused by fibromuscular dysplasia has never been reported in young children. Here we report a case of a 12-year-old boy with fibromuscular dysplasia, who underwent successful coronary intervention for acute myocardial infarction.

Plasma urokinase antigen and C-reactive protein predict angina recurrence after coronary angioplasty

This study evaluates the predictive value of several biochemical indices of the coagulation-fibrinolysis system, platelet function, and inflammatory state for angina recurrence after successful percutaneous transluminal coronary angioplasty (PTCA). We measured preprocedural and follow-up plasma levels of C-reactive protein (CRP), fibrinogen, and urokinase plasminogen activator antigen (uPA), plasminogen activator inhibitor-1 (PAI-1) activity, tissue plasminogen activator activity, and adenosine diphosphate-induced platelet aggregation in 53 patients with chronic stable angina who underwent successful elective PTCA of single hemodynamically significant lesions in coronary arteries. All patients were followed up for 12 months after PTCA. The Cox proportional hazards model was used to assess the association of variables with angina recurrence rate. At the end of the follow-up, 16 patients had angina recurrence. Among 36 clinical, biochemical, and angiographic variables, the duration of stable angina more than 12 months before PTCA (χ (2) = 5.73; P = 0.02, hazard ratio (HR) 3.7, 95 % confidence interval (CI) 1.26-10.6), high baseline levels of CRP (>7 mg/l) (χ (2) = 8.34; P = 0.004, HR 2.9, 95 % CI 1.4-5.9), uPA antigen baseline (>1 ng/ml) (χ (2) = 17.11; P = 0.0001, HR 11.5, 95 % CI 3.6-36.7) and 48 h after PTCA (χ (2) = 15.73; P = 0.0001, HR 8.8, 95 % CI 3.01-25.96), baseline PAI-1 activity (>18 IU/ml) (χ (2) = 9.37; P = 0.002, HR 7.6, 95 % CI 2.07-27.84) were significant predictors of recurrent angina by univariate analyses. According to stepwise multivariate analyses, only the levels of plasma uPA antigen and serum CRP were shown to be significant independent predictors of angina recurrence (multivariate uPA χ (2) = 8.22, P = 0.004, HR 6.2, 95 % CI 1.78-21.67; CRP χ (2) = 4.09, P = 0.04, HR 1.9, 95 % CI 1.02-3.68). High preprocedural plasma uPA and serum CRP levels are indicative of angina recurrence after successful PTCA, and are valuable for the prognosis of restenosis.

An unusual case of silent acute ST-elevation myocardial infarction following amphetamine use

We report a case of silent acute ST-elevation myocardial infarction associated with amphetamine use in a 62 years old diabetic man. The patient was devoid of chest pain and had a normal cardiac enzyme analysis at the initial presentation. A routine electrocardiogram demonstrated acute inferior wall ST-elevation myocardial infarction. Coronary angiography confirmed a total occlusion of the posterior lateral branch of right coronary artery. The patient underwent successful percutaneous transluminal coronary angioplasty with stent placement. Amphetamine abuse may play a role in acute myocardial infarction. Adverse cardiovascular manifestations of amphetamine can occur with sudden overt chest pain or present insidiously. In view of the potential association of amphetamine and myocardial infarction, physicians should not rely only upon clinical symptoms. This report highlights the diabetic patients with amphetamine abuse should undergo a routine electrocardiogram in such circumstances.

臨床 労作性狭心症患者に対す経皮的冠動脈形成術の成功は"生活の質"を改善させるか?

臨床 労作性狭心症患者に対す経皮的冠動脈形成術の成功は"生活の質"を改善させるか?

Oxidative and Antioxidative Status after Successful Percutaneous Transluminal Coronary Angioplasty in Acute Myocardial Infarction

Background: Oxidants lead to cell death through apoptosis and necrosis. The effects of reactive oxygen radicals are balanced by the antioxidant action. The aim of this study was to assess and compare the oxidative and antioxidative status, both in healthy control subjects and in patients with acute myocardial infarction after successful Percutaneous Transluminal Coronary Angioplasty (PTCA). Materials and methods: 25 patients who were re-vascularised in the first six hours of Acute ST elevated myocardial infarction and 25 healthy controls were included in the study. Erythrocyte Total Superoxide Scavenger Activity (TSSA), Non-enzymatic Superoxide Scavenger Activity (NSSA), superoxide dismutase (SOD), Nitric Oxide (NO), glutathione peroxidase (GPX) activities and glutathione (GSH), malondialdehyde (MDA) and 8 hydroxydeoxyguanosine (8-OHdG) levels were measured before PTCA (zero-time) after the 6th hour and 24th hour from PTCA in patients and once in the controls. Results: There was a decrease at MDA concentrations (3.99±1.14, 4.05±1.35, 3.62±1.11nmol/g Hb, p<0.05), however, 8-OHdG concentrations significantly increased in patient at zero-time and 6 th

Relation of Depression, Anxiety, and Quality of Life with Outcome after Percutaneous Transluminal Coronary Angioplasty

Background. Despite, increasing number of percutaneous transluminal coronary angioplasty (PTCA) being performed, there is a paucity of Indian studies on the psychological effects of PTCA. Aim. To study the relation of anxiety, depression, and health related quality of life with outcome after PTCA. Methods. A total of 35 patients undergoing PTCA were included in the present project with their informed consent. All patients filled a specially designed proforma, the Hospital Anxiety and Depression Scale, Coronary Scale, Seattle Angina Questionnaire, and a health related quality of life measure (EQ 5D) one day before undergoing PTCA. Three days after PTCA patients were reassessed with the Hospital anxiety & depression scale, Seattle angina questionnaire and the EQ 5D. Results. Analysis showed that 46% had significant anxiety and 32.1% had significant depression before PTCA. Following successful PTCA, none of the patients had significant anxiety, and only 2 (3.6%) had significant depression. On the Seattle Angina Questionnaire, physical limitation reduced from 67.9 to 48. Disease perception improved from 21.2 to 37.1. On the EQ5D, the health status improved from 42.7 before PTCA to 78.7 after PTCA. Conclusion. Successful PTCA resulted in significant reduction in anxiety, depression, and physical limitation and improvement in disease perception and health status.

Percutaneous transluminal coronary angioplasty in Nepalese diabetic patients: Do they carry extra risk to revascularization process?

Background and Objectives: There is evidence that diabetes carries risk of various complications and adverse outcome with coronary revascularisation procedures. The aim of this study was to analyze the outcomes and complications of Percutaneous Transluminal Coronary Angioplasty in Nepalese diabetic patients compared to non-diabetic patients. Method: A hospital-based comparative cross-sectional study was conducted at Norvic International Hospital, Kathmandu, Nepal. A total of 702 consecutive Percutaneous Transluminal Coronary Angioplasty patients coming to the hospital from 2002 to 2010 were included. Angioplasty was performed using radial and femoral routes in a standard setting with standard techniques. Information on other background risk factors was recorded. Success of the procedures and presence of major and minor complications were observed. Results: Of the 702 patients participating in this study, 259 were diabetic and 443 were non-diabetic. Success rates were similar: 256 (98.8%) of diabetic and 438 (98.8%) of non-diabetic had a successful Percutaneous Transluminal Coronary Angioplasty. Complications of the procedure were however higher in the diabetic patients with higher in-hospital death (odds ratio 3.4, 95% confidence Interval: 0.6-19.1), compared to non-diabetic patients. Conclusion: The overall outcome of Percutaneous Transluminal Coronary Angioplasty was equally successful in diabetic and non-diabetic populations groups. But the complications were higher with the diabetic group which were because of presence of other co-morbidities in this group and were not procedure-related. DOI: http://dx.doi.org/10.3126/jkmc.v1i1.7250 Journal of Kathmandu Medical College, Vol. 1, No. 1, Issue 1, Jul.-Sep., 2012 pp.16-20

Esophageal Long-Term ECG Reveals Paroxysmal Atrial Fibrillation

A 79-year-old man was referred for coronary angiography because of atypical chest pain. The patient's medical history included a myocardial infarction 5 years previously and well-controlled arterial hypertension. Three months before this admission he reported atypical chest pain, sometimes associated with palpitations lasting seconds up to a few minutes. Hence, he underwent ambulant 24-hour ECG, which revealed frequent atrial premature beats but no other arrhythmia. On admission, the patient was in sinus rhythm. Echocardiography showed normal ventricular function without structural heart disease. After successful percutaneous transluminal coronary angioplasty, the patient was included in a study …

Successful stenting of all three branches in a patient with single anomalous coronary artery arising from the left sinus of valsalva: A case report

Single coronary artery with diffuse aterosclerothic disease is an extremely rare anomaly. The therapeuthic options of these case are controversial. We report a case of 53-year-old man with recent anterior myocardial infarction and post-infarction angina, in whom coronary angiography showed one coronary artery arising from a single ostium in the left sinus of Valsalva giving rise to all branches and severe atherosclerotic coronary disease. The patient underwent successful percutaneous transluminal coronary angioplasty and stenting of all three branches without any complication. Stenting, as an alternative to coronary artery bypass grafting, has become an increasingly attractive option for treatment of stenosis of anomalous coronaries because the long-term results of bypass are less than ideal. For selected cases with adequate guiding support, stenting of atherosclerotic stenosis of the anomalous coronary arteries may be preferrable to surgery.

Semiurgent CABG after Successful PTCA: Should a Patent Stented Coronary Artery Be By-Passed?

Background: After a successful primary percutaneous transluminal coronary angioplasty (PTCA)/stent placement, performing bypass surgery to an artery with a patent stent during semiurgent coronary artery bypass grafting (CABG) surgeries may protect the patient against ischemic complications due to acute stent occlusion. This issue, however, is controversial. Loss of bypass graft function may occur in the early stages due to the competition between native flow and graft flow. In the present study, the effects of bypass surgery to an artery with a patent stent on the outcomes were investigated. Methods: Fifty nine patients who had undergone isolated CABG surgery within 6 weeks after a successful primary PTCA/stent placement were included in the study. Patients who had undergone emergency operation due to suspicion of acute stent occlusion and the redo cases were excluded in the study. Patients were divided into two groups; those with (Group P, protected) and without (Group NP; non-protected) coronary bypass to an artery with a patent stent. Preoperative, operative and postoperative data were collected retrospectively from the patient files. The need for urgent revascularization was recorded postoperatively. Mann-Whitney U test was used for the analysis of continuous variables, whereas categorical variables were analyzed either using Pearson's chisquare test or Fisher's exact test. Results: Of 59 patients, 35 underwent bypass surgery to the artery with patent stent, whereas bypass was not performed on 24 patients. It was observed that dual antiplatelet therapy had been performed on 20% of the patients in Group P and 87.5% of those in Group NP (p = 0.001). No acute ischemic change due to stent occlusion was determined in Group P, whereas it was observed in one patient in Group NP (p = 0.4). The prevalence of hospital mortality was found to be 8.6% and 8.3% in Group P and Group NP, respectively (p = 1). Conclusions: Although it was not statistically significant, it was observed that bypass surgery might have a protective effect against stent occlusion in patients who underwent bypass surgery. However, postoperative dual antiplatelet therapy substantially prevented stent occlusion in those without bypass surgery. On the other hand, stent-supported coronary circulation may be unsafe in case of discontinuation of clopidogrel therapy. Therefore, it was suggested that performing bypass surgery to an artery with a patent stent would be more reasonable in patients who underwent semi-urgent CABG surgery.

The Insertion/Deletion Polymorphism of the Angiotensin-Converting Enzyme Gene and the Risk for Restenosis After PTCA.

The therapeutic benefit of percutaneous transluminal coronary angioplasty (PTCA) is limited by restenosis in about 30% of patients. The underlying mechanisms are currently not well understood. Besides clinical and angiographic variables, genetic factors may be involved. We determined the angiotensin I-converting enzyme (ACE) I/D genotype as a possible risk factor for restenosis in 511 consecutive patients who had undergone successful PTCA and follow-up angiography. Clinical and angiographic variables were also considered as possible predictors of restenosis. One hundred sixty patients had restenosis as defined by a greater than 50% progression of residual stenosis of the dilated segment at follow-up angiography. There were significantly more patients with the ACE DD genotype in the restenosis than in the no-restenosis group. This difference did not remain statistically significant in an analysis of covariance that included genetic and clinical variables. Patients who subsequently developed restenosis had a higher degree of stenosis and more severe lesions before PTCA as well as less residual stenosis immediately after PTCA. We conclude that the ACE DD genotype is not an independent risk factor for restenosis after PTCA.