BRIEF REPORTS Late An@ographic Status of Coronary Angioplasty Site Which Was 60% Narrowed 4 to 12 Months After Successful Angioplasty Ziyad M.B. Ghazzal, MD, Spencer B. King III, MD, John S. Douglas, Jr., MD, and William S. Weintraub, MD estenosis R in the lirst few months after percutaneous transluminal coronary angioplasty (PTCA) is known to occur in 28 to 45% of patients and remains one of the limitations of the procedure.‘” Several studies involving small patient populations have shown that lesions that remain patent in the first few months after PTCA are un- likely to restenose thereaftetc8 In this study, we focus on a larger group of patients who had patent arteries doc- umented by angiography 4 to 12 months after angio- plasty and who were subsequently restudied for a vari- ety of clinical indications. This study evaluates the likelihood of restenosis on the late angiographic restudy. Patients screened for this study were those who un- derwent successful angioplasty (<50% residual steno- sis) to I or more coronary arterial segments between January 1984 and January 1988 at Emory University Hospital. Patients with a history of angioplasty or coro- nary artery bypass grafts were excluded. From this large population, we identi$ed the study group that consisted of patients who were found to have ail previously dilated sites patent (~50% diameter stenosis) at a first angio- graphic follow-up (Angio FU-1) 4 to 12 months after their original angioplasty and who returned for a sec- ond angiographic follow-up restudy (Angio FU-2) at Emory Hospital. One hundred twenty-seven patients formed the study group. All clinical information, procedural details, angio- graphic measurements, complications and outcome were recorded prospectively by experienced angiographers and entered into a computerized data base. The diame- ter stenosis was measured with electronic calipers. Angioplasty was per$ormed in a standard manner as previously described. Patients were pretreated with as- pirin. Heparin, 10,000 U, was administered at the be- ginning of the procedure and followed by 25,000 U ev- ery hour. The procedure was considered successful ifall lesions dilated reached a residual diameter stenosis of ~50% and there were no major complications (myocar- dial infarction, coronary artery bypass grafts or in-hos- pital death). By definition, patients in the study group were se- lected on the basis of absence of sign#cant disease (~50% diameter stenosis) in the original PTCA site or sites at Angio FU-1. Late restenosis was defined as recurrence of the stenosis (>50% diameter narrowing) at Angio FU-2. For all patients who had an apparent restenosis at the same coronary artery segment as the original PTCA, frames From the Andreas Gruentzig Cardiovascular Center, Division of Car- diology, Department of Internal Medicine, Emory University School of Medicine, 1364 Clifton Road, N.E., Suite F-606, Atlanta, Georgia. Manuscript received April 20, 1993; revised manuscript received Au- gust 20, 1993, and accepted August 30. from before and after PTCA, and Angio FU-1 and An- gio FU-2 films were carefully compared. Late resteno- sis was conjirmed when the recurrent lesion at Angio FU-2 occurred either partly or totally within the con- fines of the original PTCA lesion. At Angie FU-2, a le- sion that coincided with the region of the in#ated bal- loon during PTCA but was located completely outside the confines of the original PTCA lesion was not con- sidered to represent late restenosis. The mean age of the 127 study group patients was 58 f 10 years; 80% were men, and 15% had a history of diabetes mellitus and 48% a history of systemic hy- pertension. Mean left ventricular ejection fraction at baseline angiography was 59 IL 11%. Before the initial PTCA procedure, 93 patients (73%) had 1 -vessel disease, 28 (22%) had 2-vessel disease and 6 (5%) had 3-vessel disease (Table I). After 1 or more coronary sites were dilated, patients returned 4 to 12 months later (207 f 54 days) for Angio FU-1, at which time the majority (78 patients or 61%) had no sign@ cant coronary artery disease. Because the study group was identt$ed on the basis of patent original PTCA sites at Angie FU-1, the 49 patients with signiftcant obstruc- tive coronary artery disease had no restenosis but had obstruction in other sites. On follow-up (Figure I), 1.6% of patients underwent coronary artery bypass grafr SUCCESSFUL PRY 4-12 months 1 ANGIO FU 1 (n=127 patients) Proven Patency of Original mlSite(s) I 5-59 months 1 1 CABG PTCA 2(1.6%) 33(26%) I ANGIO FU.? In=127 patients) FlBURE 1. Coronary events end revascularlzatloa proce- dures In the period between anglographic followup (AN610 N-1 and ANal FU-2) (n = 127 patients). By def- inition, all previously dilated sRes were CM)% In dlame ter steno& at ANal FU-I. CABS = coronary artery by- pass graft surgery; MI q myocardlal lnfarctlon; P7CA = percutaneous translumbml coronary angloplasty. 892 THE AMERICAN JOURNAL OF CARDIOLOGY VOLUME 73 MAY 1,1994