Percutaneous transluminal coronary angioplasty in patients with variant angina.

Planchard, David; Waters, D.; Scholl, Jean-Marie; Crépeau, Jacques; Szlachcic, Jadwiga; Lespérance, Jacques; Hudon, Gilles; Bourassa, Martial G.

doi:10.1161/01.cir.66.4.695

Cited by 90 publications

(20 citation statements)

References 12 publications

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“…Lesion-related factors prone to restenosis are those in the proximal left anterior descending, high-grade initial stenosis, long lesions, and bypass grafts [15][16][17]. Clinical factors such as a history of diabetes mellitus [8, 18,20] and variant angina [ 19,201 may increase the incidence of restenosis. Unstable angina [8, 15,18] has been shown to have a higher incidence of restenosis.…”

Section: Risk Factors For Restenosismentioning

confidence: 99%

Restenosis after transluminal coronary angioplasty: A risk factor analysis

Arora¹,

Konrad²,

Badhwar³

et al. 1990

Cathet. Cardiovasc. Diagn.

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In order to determine the relationship of restenosis following percutaneous transluminal coronary angioplasty (PTCA) to risk factors such as hypercholesterolemia, hyperglycemia, smoking, and weight, we performed a univariate analysis to test the association of these variables with restenosis in 723 patients who had percutaneous transluminal coronary angioplasty and follow-up catheterization. Cholesterol levels were higher in younger and female subjects (less than 0.0001). Initial cholesterol did not predict restenosis, and follow-up cholesterol levels showed an inverse relationship with restenosis (P less than .02). There was a trend (P less than .09) toward decreased restenosis in those who were active smokers at the time of follow-up catheterization. No differences were seen in diabetics with hyperglycemia, in both treated and untreated groups (P = NS). A stepwise multiple logistic regression was used to simultaneously test the association of the above risk factor variables to restenosis. None of the interactions were found to be significant, except cholesterol at follow-up (P = .001). Therefore, the status of serum cholesterol, blood sugar, smoking, and weight during the time of PTCA and at follow-up catheterization may be unimportant in predicting restenosis. Thus, we conclude 1) that to better determine the effect of these variables on restenosis, they should be estimated at times other than follow-up and 2) that the pathophysiological mechanism of restenosis may have different risk factors than progression of atherosclerotic coronary artery disease.

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Section: Risk Factors For Restenosismentioning

confidence: 99%

Restenosis after transluminal coronary angioplasty: A risk factor analysis

Arora¹,

Konrad²,

Badhwar³

et al. 1990

Cathet. Cardiovasc. Diagn.

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“…Initial treatment was coronary angioplasty in six patients. 9 Drug treatment was applied initially to 186 patients. During the first part of the study period, from 1976 to 1978, perhexiline maleate was the only calcium antagonist drug available to us; therefore, 40 patients were initially treated with this drug,'0 with long-acting nitrates, or with fl-blockers.…”

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confidence: 99%

Long-term prognosis of patients with variant angina.

et al. 1987

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The long-term prognosis of variant angina and the factors influencing it were assessed in 217 consecutive patients hospitalized in our coronary care unit and followed for a mean of 65 months (range 2 to 123). Cardiac death occurred in 30 patients and an additional 54 experienced a nonfatal myocardial infarction. Survival at 1 and 5 years was 95% and 89%, respectively; survival without infarction was 83% and 69%. Coronary disease and the degree of disease activity were strong predictors of survival by Cox analysis. Survival at 1 year was 99%, and that at 5 years was 95% and 94%, respectively, for patients with one-vessel disease (n = 81) and for those without stenoses of 70% or greater (n = 87). Survival at 1 and 5 years was only 87% and 77% for those with multivessel disease (n = 40 990-997, 1987. CORONARY ARTERY SPASM accounts for the clinical manifestations of variant angina but probably does not play a major role in most patients with other coronary syndromes. Therefore, the long-term outcome of patients with variant angina and the factors influencing their prognosis may differ from those for other patients with coronary disease.The follow-up of four large series of patients with variant angina has been reported. -4 In one of these studies we described 169 such patients followed for a mean of 15 months.2 Angina disappeared spontaneously in many patients after 1 year, particularly those with coexisting organic stenoses. The purpose of this report is to describe the prognosis, and the factors influencing prognosis, in a larger series of 217 patients followed prospectively for a mean of 65 months. MethodsPatients. The diagnosis of variant angina was made in patients meeting all the following criteria: (1) buming or squeezing retrosternal chest pain at rest, (2) relief of the pain by nitroglycerin in less than 5 min, (3) ST segment elevation of at least 2 mm not present on the baseline electrocardiogram but documented during pain and disappearing with relief of pain, and (4) no subsequent evidence of myocardial necrosis. Between April 1976 and April 1986, 217 patients meeting these criteria were hospitalized at the Montreal Heart Institute.The mean age of the patients was 51 years (range 24 to 71); 165 were men and 52 were women. ST segment elevation was noted at the anterior electrocardiographic leads in 112 patients and at the inferior leads in 105 patients. In 161 cases transient ST elevation was detected during resting angina and in the remaining 56 it was documented only after administration of ergonovine.Patient management. Patients were hospitalized in the coronary care unit, where they underwent continuous electrocardiographic monitoring for at least 3 days. A complete electrocardiogram was recorded during episodes of angina at rest when possible. Coronary arteriography was performed by a percutaneous transfemoral approach by use of preformed catheters with routine filming of sagitally angulated views of the left coronary artery. Patients were not routinely given nitroglycerin before angiog...

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“…Of the 69 patients with positive DET, 57 had single-and 12 had double-vessel disease. In these last 12 patients, angioplasty was selectively performed on the ischemia-producing coronary artery, which was identified by the concordant criteria of dyssynergic territory during DET and from angiographic findings. For instance, one patient (No.…”

Section: Results Of Dipyridamole Echocardiography Test Before Angioplmentioning

confidence: 99%

Usefulness of high-dose dipyridamole echocardiography test in coronary angioplasty.

et al. 1989

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With the technical assistance of Ezio M. Ferdeghini, PhD Seventy-four consecutive patients with angina undergoing single-lesion percutaneous transluminal coronary angioplasty were evaluated with high-dose (up to 0.84 mg/kg during 10 minutes) dipyridamole echocardiography test (DET) before angioplasty and when possible, afterward. Angioplasty was clinically or angiographically successful in 63 patients and unsuccessful in 11. Before the procedure, 69 patients had a positive DET. Of these 69 patients, six with clinically unsuccessful angioplasty had a dipyridamole time (i.e., the time from the onset of dipyridamole infusion to development of asynergy) lower than the 63 patients with clinically successful angioplasty (4.2 ±2.9 vs. 7.0+2.9 minutes, mean± SD, p<0.01). In the five patients with angiographically unsuccessful angioplasty (residual stenosis diameter, >50%), coronary stenosis decreased from 89+10 to 69+22 (p=NS); DET was positive in all five before and in four of the five after the procedure (100% vs. 80%o, p=NS). In the 63 patients with angiographically successful angioplasty, coronary stenosis diameter was reduced from 85±9% to 30+10% (p<0.01). DET was positive in 58 patients before and in only 16 after the procedure (92% vs. 25%, p<0.01). In the 16 patients with positive DET, before and after angioplasty, dipyridamole time increased from 5.6±2.2 before to 7.3+±2.4 minutes immediately after the procedure (p<0.05). After an average follow-up time of 10.8±5.9 months, angina recurred in eight of 47 patients with negative DET after angioplasty and in 11 of 16 patients with positive DET (17% vs. 69%, p< 0.01). When angina symptoms recurred, a third DET was performed 1-3 days before repeat coronary angiography in 11 patients (3.6±2.7 months after the angioplasty). DET was positive in 10 of these patients, and all had coronary restenosis at angiography. DET was negative in the remaining patient, and this patient had no restenosis at angiography. These findings show that 1) before angioplasty, DET positivity with a very low dipyridamole time identifies a subset of patients at relatively higher risk of an unsuccessful procedure, 2) there is an excellent general correlation between the functional improvement assessed by DET and anatomic results of angioplasty, 3) DET positivity soon after successful angioplasty identifies a group at high risk for later recurrence of symptoms, and 4) when symptoms recur after angioplasty, DET positivity reliably identifies coronary restenosis. (Circulation 1989;80:807-815

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Percutaneous transluminal coronary angioplasty in patients with variant angina.

Cited by 90 publications

References 12 publications

Restenosis after transluminal coronary angioplasty: A risk factor analysis

Restenosis after transluminal coronary angioplasty: A risk factor analysis

Long-term prognosis of patients with variant angina.

Usefulness of high-dose dipyridamole echocardiography test in coronary angioplasty.

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