Circulation, Vol 88, 975-985, Copyright © 1993 by American Heart Association
BJ Rensing, WR Hermans, J Vos, JG Tijssen, W Rutch, N Danchin, GR Heyndrickx, EG Mast, W Wijns and PW Serruys
BACKGROUND. The renarrowing process after successful percutaneous
transluminal coronary angioplasty (PTCA) is now believed to be caused by a
response-to-injury vessel wall reaction. The magnitude of this process can
be assessed by the change in minimal lumen diameter (MLD) at follow-up
angiography. The aim of the present study was to find independent
patient-related, lesion-related, and procedure-related risk factors for
this luminal narrowing process. A model that accurately predicts the amount
of luminal narrowing could be an aid in patient or lesion selection for the
procedure, and it could improve assessment of medium-term (6 months)
prognosis. Modification or control of the identified risk factors could
reduce overall restenosis rates, and it could assist in the selection of
patients at risk for a large loss in lumen diameter. This population could
then constitute the target population for pharmacological intervention
studies. METHODS AND RESULTS. Quantitative angiography was performed on 666
successfully dilated lesions at angioplasty and at 6-month follow-up.
Multivariate linear regression analysis was performed to obtain variables
with an independent contribution to the prediction of the absolute change
in minimal lumen diameter. Diabetes mellitus, duration of angina < 2.3
months, gain in MLD at angioplasty, pre-PTCA MLD, lesion length > or =
6.8 mm, and thrombus after PTCA were independently predictive of change in
MLD. Overall prediction of the model was poor, however, percentage- correct
classification for a predicted change between -0.1 to -0.4 mm was
approximately 10%. Lesions showing no change or regression (change >
-0.1 mm) and lesions showing large progression (< or = -0.4 mm) were
more predictable (correct classification, 59.5% and 49.7%, respectively).
CONCLUSIONS. Renarrowing after successful PTCA as determined with contrast
angiography is a process that cannot be accurately predicted by simple
clinical, morphological, and lesion characteristics.
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Thoraxcenter, Erasmus University, Rotterdam, The Netherlands.
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