Risk factors for progression of atherosclerosis six months after balloon angioplasty of coronary stenosis

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Abstract

To assess the possible progression of coronary artery disease after percutaneous transluminal coronary angioplasty (PTCA) and its relation to risk factors and restenosis, 124 patients who underwent a first successful PTCA were studied. All had routine follow-up angiography 5 to 8 months after PTCA. Restenosis was defined as a 30% decrease in diameter stenosis or a return to >50% stenosis, and progression (in any nondilated site) as a 20% decrease in diameter stenosis, assessed by a videodensitometric computer-assisted technique. Univariate and multivariate analysis with respect to progression was carried out for age, sex, initial unstable angina, previous myocardial infarction, diabetes mellitus, hypertension, hypercholesterolemia (≥6.2 mmol), smoking habits, Jenkins' score, dilated artery and restenosis. Forty-one patients (33%) had restenosis, and 23 (19%) had evidence of progression; 20 (87%) of these latter patients had restenosis and 3 (13%) did not. Univariate correlates of progression were: previous myocardial infarction (p < 0.05), higher Jenkins' score (p < 0.0003) and restenosis (p < 0.0001). Restenosis was the only multivariate correlate (p < 0.00003). Progression at routine angiography after PTCA is not rare, and appears to be related to both the initial extent of coronary artery disease and restenosis.

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      The fact that it is possible that their experience was different from patients who had not had previous experience with behavior change potentially limits the generalizability of our findings. It is well established that the presence of risk factors at the time of angioplasty puts patients at high risk for restenosis.43-46 Recent studies also document the benefit of cardiac rehabilitation among patients undergoing PTCA, including improvements in self-reported function,47-50 peak oxygen consumption,47 weight and exercise capacity,48,49 and long-term cardiac morbidity and mortality.51

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    This work was supported in part by a grant from Squibb Laboratories, Princeton, New Jersey.

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