Author + information
- Received June 24, 1991
- Revision received October 10, 1991
- Accepted December 5, 1991
- Published online June 1, 1992.
- Rosa Ana Hernández, MD,
- Carlos Macaya, MD∗,
- Andrés Iñiguez, MD,
- Fernando Alfonso, MD,
- Javier Goicolea, MD,
- Antonio Fernandez-Ortiz, MD and
- Pedro Zarco, MD, FACC
- ↵∗Address for reprints: Carlos Macaya, MD, Departamento de Exploracion Cardiopulmonar, Hospital Universitario “San Carlos” C/Martín Lagos s/n, Madrid 28040, Spain.
Although many patients with restenosis after balloon coronary angioplasty have recurrence of angina, others remain asymptomatic. To assess the clinical implications of asymptomatic coronary restenosis, we analyzed clinical and angiographie characteristics of 277 consecutive patients with restenosis, 133 (48%) of whom were asymptomatic (group I) and 144 (52%) symptomatic (group II). Restenosis was documented 6 to 9 months after the index procedure, or earlier if angina recurred, and was defined as a >50% lumen narrowing (visual estimation). Group I (asymptomatic group) included fewer female (9% vs. 18%, p < 0.05) and hypertensive patients (38% vs. 56%, p < 0.005) and more patients with a previous myocardial infarction (48% vs. 28%, p < 0.05) and single-vessel disease (67% vs. 55%, p < 0.05).
Before angioplasty, symptoms had lasted for a shorter period (10 ± 25 vs. 23 ± 42 months, p < 0.001), ischemia after a recent infarction was a more frequent indication (21% vs. 10%, p < 0.05) and total revascularization more frequently obtained (74% vs. 63%, p < 0.05) in group I than in group II patients. Only a normal blood pressure, previous myocardial infarction, singlevessel disease and a shorter duration of symptoms were independent correlates of asymptomatic restenosis. No differences were found in stenosis severity before angioplasty (90% in both groups) or after angioplasty (22% ± 12% vs. 24% ± 16%).
By the time of follow-up angiography, group I patients had exercised more (9.8 ± 2.7 vs. 7.7 ± 3 metabolic exercise equivalents (METs), p < 0.05) and had achieved a faster heart rate (140 ± 21 vs. 127 ± 23 beats/min, p < 0.025), and more of them had a negative test result (33% vs. 9%, p < 0.05). Stenosis was less severe in group I patients (79 ± 15% vs. 86 ± 11%, p < 0.05), and 32% of them versus 8% of group II had <75% stenosis. After 17 ± 13 months, 15 asymptomatic patients had recurrence of angina; recurrence was considered related to restenosis in 6 (21%) of 29 patients with exercise-induced ST segment changes, in 4 (9.5%) of 42 without ST changes and in none of the 15 with ST changes and “elective” angioplasty. No group I patient died or was operated on, and only six underwent another angioplasty procedure indicated for angina. By contrast, 6 patients (4%) in group II died, 11 (8%) required surgery and 81 (56%) underwent repeat angioplasty.
It is concluded that asymptomatic coronary restenosis is a frequent phenomenon with a good prognosis mainly in patients with a negative exercise test result. Prospective, randomized studies are required to determine the potential role of repeat angioplasty in asymptomatic patients with documented restenosis and evidence of exercise-induced ST segment changes.
- Received June 24, 1991.
- Revision received October 10, 1991.
- Accepted December 5, 1991.