Luminal narrowing after percutaneous transluminal coronary angioplasty. A multivariate analysis of clinical, procedural and lesion related factors affecting long-term angiographic outcome in the PARK study. Post-Angioplasty Restenosis Ketanserin.

BACKGROUND

Long term luminal renarrowing after successful coronary balloon angioplasty is a major limitation of the technique. Knowledge of factors which influence long term luminal re-narrowing could be very valuable in selecting appropriate patients or lesions for the procedure and may therefore improve the medium term prognosis after angioplasty. Furthermore, modification or control of the identified risk factors could reduce overall restenosis. Additionally, identification of such factors would assist in the selection of high risk patients, who could then constitute the target population for pharmacological intervention studies. Thus the aims of the present study were to find independent patient, lesion and procedural related risk factors for the restenosis process.

METHODS AND RESULTS

Quantitative angiography was performed on 742 successfully dilated lesions at angioplasty and 6 months follow-up. Long-term luminal re-narrowing was defined as the absolute change in minimal luminal diameter (MLD) from post PTCA to follow up. Univariate and multiple linear regression analysis of all available clinical, lesion and procedural variables was performed to identify variables with a significant contribution to the prediction of change in MLD. Gain in MLD at angioplasty, pre PTCA MLD, total inflation time and male sex were positively related to change in MLD while a positive smoking history, vessel and maximum balloon size were negatively related. The overall prediction of the model was poor (R2-0.14) suggesting that many factors influencing the process are still outside our understanding.

CONCLUSIONS

These results indicate that re-narrowing after successful PTCA is a process which can be influenced by a number of clinical, angiographic and procedural characteristics but cannot yet be accurately predicted by these.