Prediction of native coronary artery disease progression following PTCA or CABG in the Emory Angioplasty Versus Surgery Trial.

BACKGROUND

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.

RESULTS

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).

CONCLUSIONS

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.