Can restenosis after coronary angioplasty be predicted from clinical variables?

Andreas Gruentzig Cardiovascular Center, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.

OBJECTIVES. The purpose of this study was to determine whether variables shown to correlate with restenosis in one group (learning group) could be shown to predict recurrent stenosis in a second group (validation group). BACKGROUND. Restenosis remains a critical limitation after percutaneous transluminal coronary angioplasty. Although several clinical variables have been shown to correlate with restenosis, there are few data concerning attempts to predict recurrent stenosis. METHODS. The source of data was the clinical data base at Emory University. Patients who had had previous coronary surgery and patients who underwent coronary angioplasty in the setting of acute myocardial infarction were excluded. A total of 4,006 patients with angiographic restudy after successful angioplasty were identified. They were classified into a learning group of 2,500 patients and a validation group of 1,506 patients. The correlates of restenosis in the learning group were determined by stepwise logistic regression, and a model was developed to predict the probability of restenosis and was tested in the validation group. By using various cut points for the predicted probability of restenosis, a receiver operating characteristic curve was created. Goodness of fit of the model was evaluated by comparing average predicted probabilities with average observed probabilities within subgroups on the basis of risk level determined by linear regression analysis. RESULTS. In the learning group 1,145 patients had restenosis and 1,355 did not. Correlates of restenosis were severe angina, severe diameter stenosis before angioplasty, left anterior descending coronary artery dilation, diabetes, greater diameter stenosis after angioplasty, hypertension, absence of an intimal tear, eccentric morphology and older patient age. The model derived from the learning group was used to predict restenosis in the validation group. By varying the cut point for the predicted probability of restenosis above which restenosis is diagnosed and below which it is not, a receiver operating characteristic curve was created. The curve was close to the line of identity, reflecting a poor predictive ability. However, the model was shown to fit well with the predicted probability of restenosis correlating well with the observed probability (r = 0.98, p = 0.0001). CONCLUSIONS. Clinical variables provide limited ability to predict definitively whether a particular patient will have restenosis. However, the current model may be used to predict the probability of restenosis, with some uncertainty, at least in well characterized patients who have already had angioplasty.

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				F. Ribichini, G. Steffenino, A. Dellavalle, A. Vado, V. Ferrero, T. Camilla, S. Giubergia, and E. Uslenghi Plasma Lipoprotein(a) Is Not a Predictor for Restenosis After Elective High-Pressure Coronary Stenting Circulation, September 22, 1998; 98(12): 1172 - 1177. [Abstract] [Full Text] [PDF]

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				A. Kastrati, A. Schomig, S. Elezi, H. Schuhlen, M. Wilhelm, and J. Dirschinger Interlesion Dependence of the Risk for Restenosis in Patients With Coronary Stent Placement in Multiple Lesions Circulation, June 23, 1998; 97(24): 2396 - 2401. [Abstract] [Full Text] [PDF]

				A. Schomig, A. Kastrati, S. Elezi, H. Schuhlen, J. Dirschinger, F. Dannegger, M. Wilhelm, and K. Ulm Bimodal Distribution of Angiographic Measures of Restenosis Six Months After Coronary Stent Placement Circulation, December 2, 1997; 96(11): 3880 - 3887. [Abstract] [Full Text]

				G. W. Barsness, E. D. Peterson, E. M. Ohman, C. L. Nelson, E. R. DeLong, J. G. Reves, P. K. Smith, R. D. Anderson, R. H. Jones, D. B. Mark, et al. Relationship Between Diabetes Mellitus and Long-term Survival After Coronary Bypass and Angioplasty Circulation, October 21, 1997; 96(8): 2551 - 2556. [Abstract] [Full Text]

				S. B. King III Is It Important How One Dies? : Questions for Planning Future Revascularization Trials Circulation, October 7, 1997; 96(7): 2121 - 2123. [Full Text]

				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]

				D. P. Faxon Identifying the Predictors of Restenosis: Do We Need New Glasses? Circulation, May 6, 1997; 95(9): 2244 - 2246. [Full Text]

				R. Kornowski, G. S. Mintz, K. M. Kent, A. D. Pichard, L. F. Satler, T. A. Bucher, M. K. Hong, J. J. Popma, and M. B. Leon Increased Restenosis in Diabetes Mellitus After Coronary Interventions Is Due to Exaggerated Intimal Hyperplasia: A Serial Intravascular Ultrasound Study Circulation, March 18, 1997; 95(6): 1366 - 1369. [Abstract] [Full Text]

				K. E. Kip, D. P. Faxon, K. M. Detre, W. Yeh, S. F. Kelsey, and J. W. Currier Coronary Angioplasty in Diabetic Patients: The National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry Circulation, October 15, 1996; 94(8): 1818 - 1825. [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]