UTILITY OF VARIOUS CLINICAL, NONINVASIVE, AND INVASIVE PROCEDURES FORDETERMINING THE CAUSES OF RECURRENCE OF MYOCARDIAL-ISCHEMIA OR INFARCTION GREATER-THAN-OR-EQUAL-TO-1 YEAR AFTER PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

In patients with recurrent symptoms greater than or equal to 1 year af ter successful percutaneous transluminal coronary angioplasty (PTCA), the decision of whether to proceed directly with coronary angiography or to evaluate the patient noninvasively can be difficult. To determin e which demographic, historical, clinical, and laboratory factors are useful in helping to make this decision, 76 consecutive patients who p resented >1 year (768 +/- 309 days) after successful PTCA with resolut ion of symptoms were studied. The initial PTCA successfully treated al l stenoses (except chronically occluded vessels) in all major vessels and segments. The patient group was predominantly men (68%), with a me an age of 64 +/- 10 years. A prior myocardial infarction was present i n 39 patients (51%), and there was a mean of 2.8 risk factors per pati ent. In patients who presented with recurrent symptoms, the Canadian C ardiovascular Society functional class was 2.0 +/- 0.9; 2 patients pre sented with acute infarctions, 57 were admitted to the hospital with u nstable angina, and 17 had stable angina. New electrocardiographic cha nges at rest were found in 19 of 74 patients (26%) with recurrent angi na. A thallium stress test was performed in 40 patients (53%), with a sensitivity of 77% and a specificity of 36% for the presence of a sign ificant stenosis. No nonangiographic variable was predictive of angiog raphic findings. At angiography, the number of coronary arteries with greater than or equal to 50% diameter narrowing was 1.4 +/- 1.0. Forty -two patients had stenosis at a new site, 7 had restenosis, and 27 had no new stenoses. Thus, differentiation between restenosis, disease pr ogression, and quiescence is only accomplished by coronary angiography , since neither clinical nor noninvasive parameters are predictive of changes in coronary anatomy.