Causes of coronary events after successful coronary angioplasty

OBJECTIVETo determine the causes and incidence of coronary events after successful coronary angioplasty. METHODSWe evaluated retrospectively follow-up angiograms of 60 patients with coronary events (27 with myocardial infarction, 33 with new-onset angina pectoris) from among 930 consecutive patients who underwent successful elective angioplasty between February 1985 and Apnl 1994. Patients who had undergone percutaneous transluminal coronary angioplasty to bypass grafts were excluded. RESULTSNo fatal cardiac events occurred within 6 months of percutaneous transluminal angioplasty; 10 occurred thereafter. Fifteen patients who developed early (3.9 ± 1.8 months) restenosis showed non-Q-wave infarction resulting from severe restenosis at the previously dilated site. In patients without early restenosis, cardiac events developed not from the previously dilated site, but from previously undilated, non-obstructive sites. Furthermore, it was found that the patency of the previously dilated site remained good for a long period of time (41 ±23 months) in 96% (43 of 45) of these patients. These findings indicate that the vast majority of cardiac events in patients without early restenosis resulted from new lesions distant from the previous angioplasty site. CONCLUSIONSFatal cardiac events resulting from early restenosis were rare. In patients with no evidence of restenosis, long-term patency remained good. However, a proportion of these patients developed cardiac events resulting from lesions distant from the previous angioplasty site and hence careful long-term follow-up is essential.