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CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY

Pre-existing arterial remodeling is associated with in-hospital and late adverse cardiac events after coronary interventions in patients with stable angina pectoris

^a Division of Cardiology, Department of Internal Medicine II, University of Vienna, Vienna, Austria
^* Experimental Cardiology Laboratory, Utrecht University Medical Center, Utrecht, the Netherlands

Manuscript received February 4, 2000; revised manuscript received May 8, 2000, accepted July 10, 2000.

Reprint requests and correspondence: Dr. Paul Wexberg, Division of Cardiology, Department for Internal Medicine II, University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
paul.wexberg{at}akh-wien.ac.at

OBJECTIVES

The goal of this study was to investigate the association between the atherosclerotic arterial remodeling and the incidence of cardiac events after coronary interventions in patients with stable angina.

BACKGROUND

The local mode of de novo atherosclerotic remodeling is associated with plaque vulnerability and clinical symptoms. It may, therefore, reflect plaque morphology influencing the long-term outcome after coronary interventions.

METHODS

Quantitative angiography and intravascular ultrasound were obtained in 244 patients with stable angina before and after single-vessel revascularization. On the basis of the lesion and the reference segment vessel size, patients were categorized into three groups (adaptive [AR], constrictive [CR] and intermediate [IR] remodeling). The lesion was analyzed for lumen, total vessel and plaque areas. Clinical follow-up was obtained at a mean period of 7.7 ± 3.7 months.

RESULTS

Patients with CR had a higher rate of in-hospital complications (10.9% vs. 2.9% and 2.7% in group CR vs. AR and IR, p = 0.035). In contrast, patients with AR had the highest rate of major adverse cardiac events (MACE) (44.3% vs. 25.5% in IR and 28.1% in CR, p = 0.024) with a predominance of revascularization at follow-up. Both target lesion restenosis (p = 0.036) and nontarget lesion de novo stenosis (p = 0.007) occurred more frequently in this group. Adaptive remodeling was a significant predictor of MACE in multivariate analysis.

CONCLUSIONS

Adaptive remodeling is associated with a higher rate of MACE, target lesion restenosis and nontarget de novo stenosis. This finding may be due to differential responses of the adaptively remodeled vessel to revascularization and a generally accelerated course of systemic atherosclerosis.

Abbreviations and Acronyms   AMI = acute myocardial infarction   AR = adaptive remodeling   ANOVA = analysis of variance   CABG = coronary artery bypass grafting   CI = confidence interval   CR = constrictive remodeling   EEM = external elastic membrane   IR = intermediate remodeling   IVUS = intravascular ultrasound   MACE = major adverse cardiac events   OR = odds ratio   PTCA = percutaneous transluminal coronary angioplasty

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