Risk factors for early reocclusion and luminal renarrowing in patients with acute coronary syndromes treated by direct PTCA with provisional stenting

Angioplasty in acute coronary syndromes is complicated by a high rate of ea rly vessel reocclusion and restenosis. Therefore, it is recommended to achi eve a "stent-like" result by percutaneous transluminal coronary angioplasty (PTCA) or otherwise use coronary stenting (provisional stenting). This study sought to determine angiographic and patient-related factors tha t are associated with early target vessel reocclusion or luminal renarrowin g after coronary intervention in acute coronary syndromes (ACS). In an observational prospective study we investigated 161 patients with ACS (acute myocardial infarction and unstable angina) submitted to PTCA. In 14 0 patients a followup angiography after 10 days was obtained. All angiogram s were quantitatively evaluated by computerized measurements. Target vessel reocclusion and early luminal renarrowing was observed in 10 patients (7.1%) and 19 patients (13.6%), respectively. Using univariate ana lysis, significant risk factors (P < 0.05) for early reocclusion and renarr owing were diabetes mellitus (relative risk [RR] 6.1 and 5.0), arterial hyp ertension (RR 7.7 and 3.3), postprocedural lesion length greater than or eq ual to 2.5 mm (RR 6.8 and 7.1), postprocedural minimal lumen diameter less than or equal to 2.5 mm (RR 9.0 and 5.8), residual stenosis greater than or equal to 25% (RR 4.8 and 3.5) and absence of stents (RR 4.1 and 3.2). More over, in multivariate analysis hypertension and postprocedural lesion lengt h could be identified as independent risk factors for reocclusion and renar rowing. Diabetes mellitus was found to be art independent risk factor for r enarrowing. Conclusions: In a consecutive series of patients with ACS undergoing PTCA w ith provisional stenting the occurrence of early target vessel reocclusion and luminal renarrowing is lower than previously reported fur this subset o f patients treated by PTCA alone. Adverse outcome is related to absence of stents, angiographic factors (residual stenosis, lesion length, minimal lum en diameter after procedure) and patient-related factors such as diabetes a nd hypertension.