Multiple coronary angioplasty: a model to discriminate systemic and procedural factors related to restenosis

Montreal Heart Institute, Quebec, Canada.

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 catheterization were similar to the 87 patients that did not. Overall, restenosis occurred in 74 (34%) of 215 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 multivariate logistic regression analysis, only percent stenosis before angioplasty (p less than 0.01), diabetes mellitus (p less than 0.01) and percent stenosis after angioplasty (p less than 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 less than 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.

This article has been cited by other articles:

				G. Heper, T. Durmaz, S. Namik Murat, and E. Ornek Clinical and Angiographic Outcomes of Diabetic Patients After Coronary Stenting: A Comparison of Native Vessel Stent Restenosis Rates in Different Diabetic Subgroups Angiology, May 1, 2002; 53(3): 287 - 295. [Abstract] [PDF]

				W. R. P. Agema, J. W. Jukema, S. N. Pimstone, and J. J. P. Kastelein Genetic aspects of restenosis after percutaneous coronary interventions;towards more tailored therapy Eur. Heart J., November 2, 2001; 22(22): 2058 - 2074. [PDF]

				E. Van Belle, K. Abolmaali, C. Bauters, E. P. McFadden, J.-M. Lablanche, and M. E. Bertrand Restenosis, late vessel occlusion and left ventricular function six months after balloon angioplasty in diabetic patients J. Am. Coll. Cardiol., August 1, 1999; 34(2): 476 - 485. [Abstract] [Full Text] [PDF]

				A. Abizaid, R. Kornowski, G. S. Mintz, M. K. Hong, A. S. Abizaid, R. Mehran, A. D. Pichard, K. M. Kent, L. F. Satler, H. Wu, et al. The influence of diabetes mellitus on acute and late clinical outcomes following coronary stent implantation J. Am. Coll. Cardiol., September 1, 1998; 32(3): 584 - 589. [Abstract] [Full Text] [PDF]

				P. Alaigh, C. J. Hoffman, G. Korlipara, A. Neuroth, J. P. Dervan, W. E. Lawson, and M. B. Hultin Lipoprotein(a) Level Does Not Predict Restenosis After Percutaneous Transluminal Coronary Angioplasty Arterioscler Thromb Vasc Biol, August 1, 1998; 18(8): 1281 - 1286. [Abstract] [Full Text] [PDF]

				E. Van Belle, C. Bauters, E. Hubert, J.-C. Bodart, K. Abolmaali, T. Meurice, E. P. McFadden, J.-M. Lablanche, and M. E. Bertrand Restenosis Rates in Diabetic Patients : A Comparison of Coronary Stenting and Balloon Angioplasty in Native Coronary Vessels Circulation, September 2, 1997; 96(5): 1454 - 1460. [Abstract] [Full Text]

				R. J.G. Peters, W. E.M. Kok, C. Di Mario, P. W. Serruys, F. W.H.M. Bar, G. Pasterkamp, C. Borst, O. Kamp, J. G.F. Bronzwaer, C. A. Visser, et al. Prediction of Restenosis After Coronary Balloon Angioplasty: Results of PICTURE (Post–IntraCoronary Treatment Ultrasound Result Evaluation), a Prospective Multicenter Intracoronary Ultrasound Imaging Study Circulation, May 6, 1997; 95(9): 2254 - 2261. [Abstract] [Full Text]

				R. L. Desmarais, I. J. Sarembock, C. R. Ayers, S. M. Vernon, E. R. Powers, and L. W. Gimple Elevated Serum Lipoprotein(a) Is a Risk Factor for Clinical Recurrence After Coronary Balloon Angioplasty Circulation, March 1, 1995; 91(5): 1403 - 1409. [Abstract] [Full Text]

				B. Stein, W. S. Weintraub, S. S.P. Gebhart, C. L. Cohen-Bernstein, R. Grosswald, H. A. Liberman, J. S. Douglas Jr, D. C. Morris, and S. B. King III Influence of Diabetes Mellitus on Early and Late Outcome After Percutaneous Transluminal Coronary Angioplasty Circulation, February 15, 1995; 91(4): 979 - 989. [Abstract] [Full Text]

				W. S. Weintraub, S. J. Boccuzzi, J. L. Klein, A. S. Kosinski, S. B. King, R. Ivanhoe, J. C. Cedarholm, M. E. Stillabower, J. D. Talley, S. J. DeMaio, et al. Lack of Effect of Lovastatin on Restenosis after Coronary Angioplasty N. Engl. J. Med., November 17, 1994; 331(20): 1331 - 1337. [Abstract] [Full Text]

				C. Landau, R. A. Lange, and L. D. Hillis Percutaneous Transluminal Coronary Angioplasty N. Engl. J. Med., April 7, 1994; 330(14): 981 - 993. [Full Text]

				J. P. Gapinski, J. V. VanRuiswyk, G. R. Heudebert, and G. S. Schectman Preventing Restenosis With Fish Oils Following Coronary Angioplasty: A Meta-analysis Arch Intern Med, July 12, 1993; 153(13): 1595 - 1601. [Abstract] [PDF]