EFFICACY OF A 3RD CORONARY ANGIOPLASTY FOR A 2ND RESTENOSIS - SHORT-TERM RESULTS, LONG-TERM FOLLOW-UP, AND CORRELATES OF A 3RD RESTENOSIS

Objective-To report on the short-term and long-term results of patient s who underwent a third coronary balloon angioplasty for a second rest enosis and to identify the correlates of a third clinical restenosis. Design-A retrospective analysis of clinical, angiographic, and procedu re related variables of a consecutive series of patients. Patients-62 patients (mean (range) age 53 (31-72) years; 84% men) who underwent a third coronary balloon angioplasty of a single coronary artery segment at which restenosis had occurred after two previous angioplasty proce dures between 1986 and 1992. Results-Procedure success was achieved in 56 patients (90%). Complications included one myocardial infarction ( 2%) and one emergency coronary artery bypass surgery (2%). Complete fo llow up data were available (median (range) 48 (12-94) months). During the follow up period, four patients (6%) died, two (3%) had a non-fat al myocardial infarction, and five (8%) underwent elective coronary ar tery bypass surgery. Nine patients (14%) underwent a fourth angioplast y for a third clinical restenosis, and three (5%) had a fourth angiopl asty procedure for new coronary lesions. The cumulative probability of survival for all 62 patients was 97% and 95% at I and 5 years, respec tively. The 1 and 5 year freedom from death, infarction, bypass surger y, and repeat angioplasty was 82% and 66.6%, respectively. At census, of the 58 survivors, 31 (53%) were asymptomatic and only eight (14%) c omplained of angina grade ill or IV (P < 0.001). A third clinical rest enosis occurred in 22 (39%) of the 56 patients who had initially succe ssful procedures. Multiple stepwise logistic regression analysis ident ified the interval between the second and third angioplasty procedure as the only independent predictor of a third clinical restenosis (P = 0.004). Conclusions-A third coronary angioplasty for a second restenos is can be performed safely and effectively and should be considered as an integral part of the overall coronary angioplasty revascularisatio n strategy. The incidence of a third clinical restenosis remains high, however, and is correlated with the interval between the previous ang ioplasty procedures.