Predictors of angiographic findings when chest pain recurs after successful coronary angioplasty

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Abstract
The angiographic findings of 569 patients who underwent repeat coronary angiography for recurrence of chest pain after successful coronary angioplasty were evaluated. On the basis of angiographic findings, 250 patients (44%) were classified as having restenosis, 72 (13%) incomplete revascularization, 115 (20%) new significant coronary artery lesions, and 132 (23%) no significant disease. The number of diseased vessels at the time of coronary angioplasty (P<0.001), number of vessels dilated (P<0.001), and in particular, the time from angioplasty to recurrent chest pain (P<0.001), were predictive of angiographic findings. When chest pain recurred within 4 weeks of angioplasty, 70% of patients had either incomplete revascularization or no significant coronary artery stenosis, when it recurred between 4 and 24 weeks of angioplasty, restenosis was the most common finding (71%), and when it recurred more than 24 weeks after angioplasty, new disease was the most common finding, occurring in 53% of patients. Of the 115 patients who developed new disease, angioplasty was initially performed on 133 vessels, and222 vessels were not dilated. At repeat angiography, 81 of the 133 vessels (61%) that had had angioplasty and 109 of the 222 vessels (49%) that had not had angioplasty had new lesions; this difference was significant at P=0.03. In conclusion, although the most common cause of recurrence of chest pain after initially successful coronary angioplasty was restenosis, other mechanisms may also be responsible. The time from coronary angioplasty to onset of recurrent chest pain was the most powerful predictor of angiographic outcome. The incidence of new lesion development was higher in the vessels that had instrumented angioplasty, possibly reflecting accelerated atherosclerosis or increased fibrocellular proliferation from intimal injury.

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