Coronary Artery Disease
Clinical and sequential angiographic follow-up six months and 10 years after successful percutaneous transluminal coronary angioplasty☆

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Abstract

Sequential angiographic follow-up is needed for interpretating coronary events that occur after successful percutaneous translumial coronary angioplasty (PTCA). One hundred eight consecutive patients who had undergone successful dilatation were followed for 10 years, and quantitative sequential angiograms were recorded at 6 months (n = 101) and 10 years (n = 68). The 10-year event rate was: 5.8 ± 2.4% for cardiac death, 9.7 ± 3.3.% for Q-wave acute myocardial infarction, 18.3 ± 4.5% for additional surgery, and 22.4 ± 4.9% for repeated angioplasty. Using Cox’s proportional-hazards regression, multivessel coronary artery disease (CAD) (RR 5.6; 95% confidence intervals [CI] 1.2 to 24.7; p = 0.02), restenosis within 6 months (RR 7.8; 95% CI 3.1 to 20.0; p = 0.0001), and CAD progression over 10 years (RR 10.6; 95% CI 1.3 to 87.1; p = 0.004) were the strongest predictors of all-cause death, repeated PTCA, and additional surgery, respectively, after controlling for age and coronary risk factors. The minimal luminal diameter of 48 narrowings with complete sequential angiographic follow-up and without restenosis remained stable from 6 months (2.13 ± 0.60 mm) to 10 years (2.18 ± 0.61 mm). Disease progression was similar in nondilated arteries and dilated arteries (32% vs 30%). The 10-year risk of coronary events was higher in patients with baseline multivessel CAD than in those with 1-vessel CAD because of more frequent progression of CAD (RR 3.8; 95% CI 1.6 to 6.8; p = 0.001). Thus, early cardiac events after successful PTCA were related to restenosis, and late events to CAD progression. Nevertheless, after the restenosis period, the target lesion remained stable for the next 10 years. Coronary disease progression was not related to the angioplasty procedure.

Section snippets

Patients

From September 1981 to December 1985, 108 patients (125 narrowings) underwent clinically successful PTCA among 165 procedures at a single clinical site. One-vessel CAD, defined as ≥50% luminal diameter stenosis in 1 of the 3 major coronary arteries, was observed in 65 patients. Two- and 3-vessel CAD was observed in 34 and 9 patients, respectively. Clinically successful primary PTCA was defined as a reduction in luminal diameter stenosis to <50% without major ischemic complications in the

Baseline and 10-year characteristics of patients

The baseline characteristics of the 108 consecutive patients who had successful PTCA are described in Table I. Ten-year clinical and angiographic characteristics of 94 patients among the 95 survivors are also compared with their matched baseline characteristics. There were fewer smokers (16% vs 56%, p <0.0005), and they were less symptomatic. Baseline characteristics of the 68 patients with and the 40 patients without 2 sequential follow-up angiograms were similar (Table II). Thirty-one

Discussion

This study on the 10-year follow-up of our first 108 patients successfully treated with PTCA is comparable not only to the 1977 to 1981 cohort of the National Heart, Lung, and Blood Institute Registry,9 but also to the Early Zurich Experience,6 the 10-year results from the San Francisco Heart Institute, and from the Mayo Clinic.7

Our 10-year cardiac death rates seem to compare favorably with those reported on the natural history of CAD for surgical candidates, which were 23% for 1-vessel, and

Acknowledgements

We are indebted to Rocio Paz del Rio for her secretarial assistance.

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    ☆

    This study was supported by grant 94/1299 from the Fondo de Investigación, Sanitaria, Madrid, Spain.

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