Circulation, Vol 73, 710-717, Copyright © 1986 by American Heart Association
PP Leimgruber, GS Roubin, J Hollman, GA Cotsonis, B Meier, JS Douglas, SB King Jr and AR Gruentzig
To determine risk factors for restenosis, we studied 998 patients who
underwent elective coronary angioplasty (PTCA) to native coronary arteries
between July 1980 and July 1984. Restenosis, defined as a luminal narrowing
of greater than 50% at follow-up, was present in 302 patients (30.2%).
Univariate analysis of 29 factors revealed seven factors related to
restenosis: vessel dilated (circumflex coronary artery 18%, right coronary
artery 27%, left anterior descending artery 34%; p less than .01), final
gradient of 15 mm Hg or less compared with greater than 15 mm Hg (27% vs
38%, p less than .01), duration of angina greater than 2 months compared
with angina of shorter duration (27% vs 35%, p = .01), post-PTCA stenosis
of 30% or less compared with 31% to 50% (28% vs 36%, p less than .025),
stable vs unstable angina (26% vs 34%, p less than .05), presence vs
absence of intimal dissection (26% vs 32%, p = .07), and female gender vs
male gender (25% vs 32%, p = .08). Multivariate analysis revealed five
factors independently related to increased risk of restenosis in the
following order of importance: PTCA in the left anterior descending artery,
absence of intimal dissection immediately after PTCA, final gradient
greater than 15 mm Hg, a large residual stenosis after PTCA, and unstable
angina. Restenosis after PTCA is a multifactorial problem. The hemodynamic
and angiographic result at the time of PTCA significantly influences long-
term outcome, but additional measures aimed at reducing the rate of
recurrence of atherosclerotic plaque are required.
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