MULTIPLE CORONARY ANGIOPLASTY - A MODEL TO DISCRIMINATE SYSTEMIC AND PROCEDURAL FACTORS RELATED TO RESTENOSIS

[摘要] To assess the interrelation of clinical and procedural factors responsible for restenosis, 119 patients undergoing coronary arteriography were studied a mean of 5.8 .+-. 3 months after successful multiple percutaneous transluminal coronary angioplasty. In all clinical, angiographic and procedural variables, the 119 patients undergoing repeat chatheterization were similar to the 87 patients that did not. Overall, restenosis occurred in 74 (34%) of 21 lesions. Sixty-three patients had no restenosis, 44 had at least one restenosis and 12 had restenosis at all angioplasty sites. The statistical distribution of restenoses did not follow a binomial model, suggesting that restenosis is more than a lesion-specific phenomenon. Of all the clinical and procedural variables assessed by multivar iable logistic regression analysis, only percent stenosis before angioplsty (P < 0.01), diabetes mellitus (p < 0.01) and percent stenosis after angioplasty (p < 0.05) were predictive of restenosis in the entire group. Patients with no restenosis and patients with restenosis at all sites were not different with respect to procedural variables; however, patients with restenosis at all sites more often (p < 0.05) had diabetes and recent onset angina. In contrast, patients with no restenosis differed from patients with isolated restenosis with respect to procedural variables: severity of stenosis before and after angioplasty, balloon/artery lumen ratio and maximal inflation pressure. Thus, procedural factors may be more related to isolated restenosis, but patient-related factors such as diabetes and recent onset angina may play a more important role in patients with multiple restenoses.

[发布日期] 1988-08-01