Luminal narrowing after percutaneous transluminal coronary angioplasty. A study of clinical, procedural, and lesional factors related to long-term angiographic outcome. Coronary Artery Restenosis Prevention on Repeated Thromboxane Antagonism (CARPORT) Study Group

• Published in: Circulation (New York, N.Y.) Vol. 88; no. 3; pp. 975 - 985
• Main Authors: Rensing, B J, Hermans, W R, Vos, J, Tijssen, J G, Rutch, W, Danchin, N, Heyndrickx, G R, Mast, E G, Wijns, W, Serruys, P W
• Format: Journal Article
• Language: English
• Published: United States 01.09.1993
• Subjects: Angioplasty, Balloon, Coronary; Biphenyl Compounds - therapeutic use; Coronary Angiography; Coronary Disease - diagnostic imaging; Coronary Disease - epidemiology; Coronary Disease - therapy; Female; Follow-Up Studies; Heptanoic Acids - therapeutic use; Humans; Male; Middle Aged; Receptors, Thromboxane - antagonists & inhibitors; Recurrence; Regression Analysis; Risk Factors; Time Factors
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.cir.88.3.975

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. 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). Renarrowing after successful PTCA as determined with contrast angiography is a process that cannot be accurately predicted by simple clinical, morphological, and lesion characteristics.