AGGRESSIVE PATTERN OF ANGINA AFTER SUCCESSFUL CORONARY ANGIOPLASTY - THE ROLE OF CLINICAL AND ANGIOGRAPHIC FACTORS

To assess possible clinical and angiographic factors associated with a cute coronary events following PTCA, we performed quantitative angiogr aphy in 168 consecutive patients who had undergone successful angiopla sty in a native vessel (94 for stable angina, 74 for unstable angina), and who were restudied (24 +/- 15 weeks; range 4 to 52) because of re current anginal symptoms. Of the 168 patients, 38 (Group 1) were restu died because the pattern of angina,vas aggressive (unstable angina in 31, myocardial infarction in 7) and 130 because of effort-related angi na (Group 2). The two patient groups were well matched for extent of i nitial disease but patients in Group were younger (P=0.03). PTCA for u nstable angina was originally performed more frequently in Group I tha n in Group 2 (27 of 38 patients (71%) vs 47 of 130 patients (36%), P=0 .0001). The overall restenosis late (68% vs 62%) and the non-occlusive restenosis rate (45% vs 57%) were not significantly different between Groups I and 2. However; occlusive restenosis (total occlusion at the site of the angioplasty) occurred in IO patients (26%) in Group I com pared with eight (6%) in Group 2(P=0.0004). Disease progression in non -dilated segments occurred in nine patients (24%) in Group I and in ro (8%) in Group 2 (P=0.0006). Our conclusion is that patients who requi re re-investigation as a result of angina which has become aggressive following PTCA are usually those who originally underwent PTCA for uns table angina. These patients have a higher incidence of occlusive rest enosis or disease progression.