USEFULNESS OF THE SUBSTITUTION OF NONANGIOGRAPHIC END-POINTS (DEATH, ACUTE MYOCARDIAL-INFARCTION, CORONARY-BYPASS AND OR REPEAT ANGIOPLASTY) FOR FOLLOW-UP CORONARY ANGIOGRAPHY IN EVALUATING THE SUCCESS OF CORONARY ANGIOPLASTY IN PATIENTS WITH ANGINA-PECTORIS/

Historically, restenosis after coronary angioplasty has been assessed angiographically at about 6 months. The desirability of avoiding routi ne follow-vp angiography as well as the recognition that angiographic and clinical assessments are not necessarily the same has prompted gre ater interest in following patients clinically after angioplasty. Clin ical restenosis has been defined as the composite of death, myocardial infarction, coronary surgery, or additional angioplasty within 6 mont hs of the index procedure. Clinical restenosis was observed in 2,340 o f 11,473 patients (20.4%). The mortality at 6 months was only 1%. Alth ough there were somewhat more acute myocardial infarctions and coronar y surgical procedures, the most frequent event was additional angiopla sty. Angiographic restenosis was noted in 30% of patients without clin ical restenosis and in 87% of patients with clinical restenosis (p <0. 0001). Patients with clinical restenosis were less likely to be women, had more systemic hypertension, diabetes mellitus, more severe angina originally, fewer prior myocardial infarctions, more multivessel and left anterior descending artery disease, more multisite procedures, mo re branch site procedures, and longer and tighter stenoses both before and after the procedure. The year of the procedure did not correlate with restenosis. Clinical restenosis is less common than angiographic restenosis and the most common event is additional angioplasty. Althou gh clinical restenosis is rarely fatal, it does result in inconvenienc e and additional resource consumption. (C) 1998 by Excerpta Medico, In c.