Zhao Xue-Qiao, Kosinski Andrzej S, Barnhart Huiman X, Superko H R, King Spencer B
Department of Medicine, Cardiology Division, University of Washington School of Medicine, Seattle, WA 98103, USA.
Med Sci Monit. 2003 Feb;9(2):CR48-54.
The natural history of atherosclerosis progression following revascularization procedures (PTCA or CABG) limits the long-term benefits of these procedures and requires continuation of risk management.
MATERIAL/METHODS: Of 392 patients with multivessel disease randomized to an initial strategy of PTCA or CABG in the Emory Angioplasty Versus Surgery Trial (EAST), 298 patients (152 PTCA and 146 CABG) completed 3-year angiographic follow-up. Native coronary artery disease progression was defined as lesions with <50% diameter stenosis (%S) at baseline, measured by QCA, that increased at least 10%S to become >or=50%S during the 3-year follow-up. Major ischemic events (new Q-wave myocardial infarction, a large reversible thallium defect or additional revascularization procedures) attributed to these new lesions were determined based on the ECG ischemic changes and/or the details of the coronary anatomy.
Of 298 patients, 53 (18%) (15% of PTCA and 21% of CABG) developed at least one significant new native coronary artery lesion. Of 136 patients with events, 19 (14%) had such events due to progression. In multivariate analysis, native coronary disease progression was independently correlated with hypertension (OR=2.4, p=0.03), ST segment depression =1mm on baseline ETT (OR=2.7, p=0.01), and percent of small LDL particles (LDL IIIa-IVb) (OR=1.2 for every 5% increase, p=0.01).
In EAST, the native CAD progression accounted for one in seven major ischemic episodes over a 3-year follow-up. Patients with metabolic atherogenic risk profiles were more likely to have disease progression. These findings indicate the importance of more aggressive risk factor modification following revascularization.
