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(Circulation. 1995;91:1410-1418.)
© 1995 American Heart Association, Inc.
Articles |
Restenosis After Delayed Coronary Angioplasty of the Culprit Vessel in Patients With a Recent Myocardial Infarction Treated by Thrombolysis
From the Service de Cardiologie B et Hémodynamique, Hôpital Cardiologique, Lille Cedex, France.
Correspondence to M.E. Bertrand, MD, Service de Cardiologie B, Hôpital Cardiologique, Boulevard du Professeur J Leclercq, 59037 Lille Cedex, France.
Background Clinical follow-up after percutaneous transluminal coronary angioplasty (PTCA) of an infarct-related lesion has demonstrated a low incidence of recurrent symptoms and repeated revascularization. In the absence of systematic angiographic follow-up, this low rate of clinical restenosis may reflect either a truly lower incidence of anatomic restenosis or the lack of recurrent symptoms in patients with extensive infarction in the territory of the restenotic vessel.
Methods and Results We studied 300 consecutive patients who,
after a thrombolysis for myocardial infarction, underwent delayed
(10.5±6 days after the myocardial infarction) PTCA of the
infarct-related lesion. Procedural success was obtained in 253 patients
(84%), and angiographic follow-up was performed in 205 of this group
(81%) at a mean of 7.3±1.9 months. Restenosis (defined as the
recurrence of >50% stenosis) was present in 105 patients (51%).
Only 34 of the 105 patients (32%) with angiographic restenosis were
symptomatic; the other 68% had clinically silent restenosis. Of these
105 patients, 27 (13% of the total population undergoing follow-up
angiography) had reocclusion at the dilated site at follow-up. The
severity of the stenosis at follow-up and the late loss in minimal
lumen diameter followed a nearly Gaussian distribution if the lesions
that were totally occluded at follow-up were excluded. By multivariate
analysis, two independent predictors of reocclusion were
identified: a small reference diameter (P<.0005) and the
presence of collateral vessels before the procedure
(P<.01). Only one factor was associated with restenosis in
the 178 patients who did not have reocclusion at follow-up: a
Thrombolysis in Myocardial Infarction grade 
2 before the procedure
(P<.0001). At follow-up, there was a significantly
(P<.01) higher ejection fraction in patients without
restenosis (56.1±13.4%) and in patients with restenosis without total
occlusion (56.0±13.8%) than in patients with reocclusion
(46.4±13.0%).
Conclusions Despite a satisfactory clinical outcome, delayed PTCA of an infarct-related lesion is associated with a high rate of angiographic recurrence. Two distinct mechanisms account for recurrent stenosis: progressive luminal renarrowing as documented after angioplasty of stable lesions and reocclusion of the infarct-related lesion. Only reocclusion is associated with a deterioration in left ventricular function at follow-up.
Key Words: angioplasty • vessels • circulation
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