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KEY WORDS: PTCA, restenosis, repeat PTCA, PTCA outcome determinants. (PTCA) Since its introduction' 12 ' successful percutaneous long-term success of PTCA. Reported restenosis transluminal coronary angioplasty (PTCA) has rates (14-47%) vary, depending in part on the denbeen shown to relieve angina and myocardial nition used, but according to the larger series' 18 " 22 ', ischaemia as assessed by exercise electrocardiogone patient in three with successful PTCA must raphy 13 ', thallium scintigraphy* 3 ' 4 ', and measureexpect recurrence, most of them within 6-8 months ment of coronary blood flow and myocardial after the intervention. Repeat PTCA has been metabolism' 5 ' 6 '. The original indications' 2 ' have been done with a higher primary success rate and fewer expanded' 7 " 171 . But regardless of selection criteria, complications than the initial procedure. Nevertherestenosis with recurrence of myocardial ischaemia less, there remains a substantial rate of second and symptoms remains the major problem limiting recurrences' 23 " 251 . The presence of angina as an indicator for restenosis has a predictive accuracy of only 56% Submitted for publication on 23 June 1986 and in revised form 21 after first and 67% after Second PTCA according tO OctobCTl986 the NHLBI report" 8231 . One patient in four with For the period that this work was carried out, Dr Rapold was restenosis has no chest pain. In a population at high supported by a grant oftheSwisi National Science Foundation. Restenosis is the main problem limiting long-term success of percutaneous transluminal coronary angioplasty

To assess the interrelation of clinical and procedural factors responsible for restenosis, 119 patients undergoing coronary arteriography were studied a mean of 5.8 +/- 3 months after successful multiple percutaneous transluminal coronary angioplasty. In all clinical, angiographic and procedural variables, the 119 patients undergoing repeat catheterization were similar to the 87 patients that did not. Overall, restenosis occurred in 74 (34%) of 215 lesions. Sixty-three patients had no restenosis, 44 had at least one restenosis and 12 had restenosis at all angioplasty sites. The statistical distribution of restenoses did not follow a binomial model, suggesting that restenosis is more than a lesion-specific phenomenon. Of all the clinical and procedural variables assessed by multivariate logistic regression analysis, only percent stenosis before angioplasty (p less than 0.01), diabetes mellitus (p less than 0.01) and percent stenosis after angioplasty (p less than 0.05) were predictive of restenosis in the entire group. Patients with no restenosis and patients with restenosis at all sites were not different with respect to procedural variables; however, patients with restenosis at all sites more often (p less than 0.05) had diabetes and recent onset angina. In contrast, patients with no restenosis differed from patients with isolated restenosis with respect to procedural variables: severity of stenosis before and after angioplasty, balloon/artery lumen ratio and maximal inflation pressure. Thus, procedural factors may be more related to isolated restenosis, but patient-related factors such as diabetes and recent onset angina may play a more important role in patients with multiple restenoses.

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