RESTENOSIS OR RAPID PROGRESSION IN NONDILATED SITES ARE NOT PREDICTORS OF LATE SPONTANEOUS CORONARY EVENTS

The present study was designed to assess the prognostic value of clini cal and angiographic factors, and especially restenosis or rapid progr ession in non-dilated sites, on major spontaneous coronary events at l ong-term follow-up after a first successful coronary angioplasty perfo rmed for angina pectoris. A second aim was to assess the prognostic fa ctors and especially restenosis in asymptomatic patients after angiopl asty. The first 352 consecutive patients undergoing a successful coron ary angioplasty were selected and followed-up. The following variables : age, sex, unstable angina, previous myocardial infarction, diabetes, hypercholesterolemia, tobacco consumption, hypertension, fibrinogen, coronary extent, single or multiple dilatation, restenosis, new progre ssion, clinical deterioration of anginal status just before angiograph ic restudy or asymptomatic status were subjected to a stepwise regress ion analysis. Restenosis (a loss of 30% in diameter and/or a return to a >50% stenosis) and progression in non-dilated segments (a 20% reduc tion in diameter) were assessed by a computer-assisted method. Cardiac death, new myocardial infarction or new unstable angina, at long-term follow-up after angiographic restudy, were regarded as spontaneous co ronary events and pooled in a single dependent variable. Thus 41 patie nts had a coronary event. In the overall population, clinical deterior ation of anginal status (p < 0.001, relative risk: 3.65) and fibrinoge n (p < 0.05, relative risk: 1.03) were independent predictors of spont aneous coronary events. Restenosis or new progression were not predict ors. In asymptomatic patients (n = 187), fibrinogen (p < 0.01, relativ e risk = 1.06) was the only predictor and restenosis was not an indepe ndent predictor of spontaneous coronary events. The best predictor of spontaneous coronary events at long-term follow-up after a first succe ssful coronary angioplasty is clinical deterioration in anginal status in the months following the procedure. Restenosis does not appear as an independent predictor. Rapid progression observed in non-dilated si tes is not an important prognostic factor. (C) 1997 Elsevier Science I reland Ltd.