Risk factors, time course and treatment effect for restenosis after successful percutaneous transluminal coronary angioplasty of chronic total occlusion

Advances in technology and operator experience, and increased use of angiography early after myocardial infarction have led to greater use of percutaneous transluminal coronary angioplasty (PTCA) for chronic, total coronary artery occlusions. To better assess long-term outcome, 257 consecutive patients with successful PTCA of a total occlusion with late angiographic follow-up from 484 patients (53%) with PTCA success were reviewed. The mean +/- standard deviation patient age was 54 +/- 10 years, 79% were men, the duration of total occlusion was 11 +/- 15 weeks and the post-PTCA diameter stenosis was 24 +/- 12%. Eighty-two, 27 and 63% of patients received long-term aspirin, dipyridamole and warfarin therapy, respectively. Angiography at 8 +/- 8 months demonstrated restenosis (>=50% diameter stenosis) in 41% of patients restudied within 6 months and in 66% of patients restudied within 12 months by life table analysis. In multivariate regression analysis of 19 variables, 2 were independently correlated with the occurrence of restenosis: post-PTCA diameter stenosis > 30% (p = 0.02) and coronary artery dilated (left anterior descending and right coronary arteries greater than the left circumflex coronary artery) (p = 0.05). In log rank analysis that also considered the timing of angiographic detection of restenosis, dilatation of a proximal left anterior descending stenosis was also a significant predictor of restenosis (p = 0.01), and dilatation within 4 weeks of the presumed time of occlusion was only weakly predictive (p = 0.11). Thirty-five patients (27% of those with restenosis) had reocclusion at the site of PTCA, but only 3 patients (2%) had an associated myocardial infarction. There was no relative beneficial effect of any treatment on the risk of restenosis. Thus, (1) restenosis after PTCA of chronic total occlusion is very common; (2) restenosis is predicted by the angioplasty results and angioplasty site; (3) the clinical detection of restenosis does not appear to plateau at 6 months; (4) reocclusion is not uncommon, but seldom results in myocardial infarction; and (5) there was no apparent relative treatment effect of aspirin, dipyridamole or warfarin.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/27967/1/0000398.pd