Chandrasekar B, Bourassa M G
Research Center, Montreal Heart Institute, Montreal, Quebec, Canada.
Am Heart J. 2000 Dec;140(6):827-33. doi: 10.1067/mhj.2000.110768.
The current study was designed to determine the incidence and risk factors for unstable angina resulting from restenosis in patients undergoing percutaneous transluminal coronary angioplasty (PTCA) of saphenous vein graft (SVG), about which little data are available.
A retrospective analysis of a consecutive series of 212 patients undergoing PTCA of SVG was performed. Procedural success was achieved in 200 patients (94.3%) who formed the study group. During a follow-up of 16.8 +/- 10.2 months, 24.5% of patients presented with unstable angina resulting from restenosis. There was a higher prevalence of dyslipidemia (81. 6% vs 51.2%, P <.0002) and greater postprocedural residual stenosis (14.2% +/- 12.6% vs 7.1% +/- 11.0%, P =.007) in patients with unstable angina caused by restenosis compared with the remaining patient population. By multivariate analysis, dyslipidemia (odds ratio [OR] 3.55, 95% confidence interval [CI] 1.64-8.39, P <.002) and to a lesser extent postprocedural residual stenosis (OR 1.04, 95% CI 1.01-1.07, P <.05) were predictive of unstable angina resulting from restenosis. Among dyslipidemic patients, those not on lipid-lowering drugs during the index procedure had a significantly higher incidence of unstable angina caused by restenosis than did those on lipid-lowering drugs (P <.05).
Unstable angina caused by restenosis presents in as many as one fourth of patients undergoing PTCA of SVG. Dyslipidemia strongly, and to a lesser extent postprocedural residual stenosis, predicts its occurrence. Scrupulous attention to these modifiable risk factors may help reduce the incidence of unstable angina after SVG angioplasty.
