Circulation, Vol 90, 1239-1251, Copyright © 1994 by American Heart Association
DP Foley, R Melkert and PW Serruys
BACKGROUND: Although coronary angioplasty is increasingly applied in the
treatment of multivessel disease and a broadening range of vessel size, the
influence of vessel size itself on the late results of intervention is
unresolved. An influence of vessel size on late outcome would carry
implications for the application and evaluation of interventional devices,
which are selectively used in larger or smaller vessels. The purpose of the
present study was to investigate the influence of vessel size on both the
restenosis process and late angiographic outcome in a large homogeneous
patient group after successful percutaneous transluminal coronary
angioplasty (PTCA). METHODS AND RESULTS: The study population comprised
3072 patients with 3736 successfully dilated native primary coronary artery
lesions and satisfactory quantitative angiographic analysis in multiple
identical projections before and after PTCA and at a 6-month follow-up.
Late luminal loss, minimal luminal diameter (MLD) at follow-up, and net
luminal gain, as well as percent diameter stenosis at follow-up, net gain
in percent diameter stenosis, restenosis rates (according to three
definitions), and net gain index, were all compared among nine equally
sized groups (noniles) according to vessel size. A direct influence of
vessel size on continuous measures of late result was also evaluated by
linear regression. These evaluations provided conflicting information with
no consistent influence of vessel size emerging. To elucidate the
independent influence of vessel size on the restenosis process (late loss)
and late angiographic outcome (MLD at follow-up), multiple linear
regression analysis was performed taking into account luminal gain,
preprocedural MLD, and lesion location. In this manner, vessel size was
found to be exert a significantly positive influence on MLD at follow- up
(P < .0001) and an equally negative effect on loss. Correcting for
vessel size by using percent stenosis measurements led to an anticipated
neutralization of this influence. Lesion location in the left anterior
descending coronary artery was found to be independently associated with
greater loss and smaller MLD at follow-up (P < .0001). CONCLUSIONS:
Increasing coronary vessel size was found to be independently predictive of
decreasing late luminal loss and increasing follow-up MLD after successful
balloon angioplasty. Apparently superior or inferior late angiographic
results of new interventional devices may thus be explained in part by
preferential use in larger or smaller vessels, respectively. Devices that
can safely optimize the short-term result of intervention may realize their
ultimate long-term value in larger coronary vessels.
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Influence of coronary vessel size on renarrowing process and late angiographic outcome after successful balloon angioplasty
Department of Interventional Cardiology, Erasmus University, Rotterdam, Netherlands.
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