ANGIOGRAPHIC DETERIORATION OF TARGET CORONARY-ARTERY NARROWING AS A RESULT OF PERCUTANEOUS BALLOON ANGIOPLASTY

We evaluated the long-term angiographic outcome of balloon angioplasty by comparing original and follow-up target coronary narrowing. Rather than using restenosis to determine outcome, as in most angioplasty st udies, we took an unusual approach and analyzed outcome in terms that are commonly used in progression and regression studies after medical interventions. Quantitative angiographic measurements were undertaken in 315 narrowings with an initial diameter stenosis <90% before and af ter angioplasty and at follow-up. Angiographic deterioration (>10% inc rease in follow-up diameter stenosis) was identified in 44 (14%) narro wings. Angiographic deterioration was not influenced by age, sex, risk factors, lipid profile, or the indication for angioplasty. Deteriorat ion was also not predicted by the severity, length, or the location of the narrowing. The deteriorating narrowings had a higher recoil after dilatation compared with narrowings with angiographic improvement (21 % +/- 31% vs 12% +/- 17%, p = 0.006); the residual stenosis after angi oplasty was therefore higher. The late loss was also significantly inc reased compared with narrowings with angiographic improvement (65% +/ 26% vs 8% +/- 24%, p < 0.001). We conclude that the incidence of angio graphic deterioration of coronary disease as a result of restenosis is uncommon but not negligible. interventional cardiologists should resi st the temptation to dilate mild, silent coronary narrowings because t he procedure might have an unfavorable angiographic (and probably clin ical) effect.