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

Sequential angiographic follow-up is needed for interpretating coronary eve nts that occur after successful percutaneous translumial coronary angioplas ty (PTCA). One hundred eight consecutive patients who had undergone success ful dilatation were followed for 10 years, and quantitative sequential angi ograms were recorded at 6 months (n = 101) and 10 years (n = 68). The 10-ye ar 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 regre ssion, multivessel coronary artery disease (CAD) (RR 5.6; 95% confidence in tervals [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 d eath, repeated PTCA and additional surgery, respectively, after controlling for age and coronary risk factors. The minimal luminal diameter of 48 narr owings with complete sequential angiographic follow-up and without restenos is 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 p atients with baseline multivessel CAB than in those with I-vessel CAD becau se of more frequent progression of CAD (RR 3.8; 95% CI 1.6 to 6.8; p = 0.00 1). Thus, early cardiac events after successful PTCA were related to resten osis, and late events ta CAD progression. Nevertheless, after the restenasi s period, the target lesion remained stable for the next 10 years. Coronary disease progression was not related ta the angioplasty procedure. (C) 1999 by Excerpta Medico, Inc.