Clinical and angiographic factors associated with asymptomatic restenosis after percutaneous coronary intervention

Background-Angiographic restenosis after percutancous coronary intervention al procedures is more common than recurrent angina. Clinical and angiograph ic factors associated with asymptomatic versus symptomatic restenosis after percutancous coronary intervention were compared. Methods and Results-All patients with angiographic restenosis from the BENE STENT 1, BENESTENT II pilot, BENESTENT II, MUSIC, WEST 1, DUET, FINESS 2, F LARE, SOPHOS, and ROSE studies were analyzed. Multivariate analysis evaluat ed 46 clinical and angiographic variables, comparing those with and without angina. The 10 studies recruited 2690 patients who underwent percutaneous revascularization and 6-month follow-up angiography (86% of those eligible) . Restenosis (greater than or equal to 50% diameter stenosis) occurred in 6 07 patients and was clinically silent in 335 (55%). Male sex (P=0.008), abs ence of antianginal therapy with nitrates (P=0.0002) and calcium channel bl ockers (P=0.02) at 6 months, greater reference diameter after the procedure (P=0.04), greater reference diameter at follow-up (P=0.004), and lesser le sion severity (percent stenosis) at 6 months (P=0.0004) were univariate pre dictors of asymptomatic restenosis. By multivariate analysis, only male sex (P=0.04), greater reference diameter at follow-up (P=0.002), and lesser le sion severity at 6 months (P=0.0001) were associated with restenosis withou t angina. Conclusions-Approximately half of patients with angiographic restenosis hav e no symptoms. The only multivariate predictors of silent restenosis at 6 m onths were male sex, greater reference diameter at follow-up, and lesser le sion severity on follow-up angiography.