Skip to main content
SpringerLink
Log in

Angioplasty for stable versus unstable angina pectoris: Are unstable patients more likely to get restenosis?

A quantitative angiographic study in 339 consecutive patients

  • Published:
The International Journal of Cardiac Imaging Aims and scope Submit manuscript

Summary

Current evidence with regard to the possible association between clinical expression of coronary disease prior to the time of angioplasty, and the subsequent risk of restenosis following successful dilatation, remains inconclusive.

To prospectively compare the incidence of restenosis in stable versus unstable angina pectoris patients, follow-up angiography was performed in 85 percent of patients from a consecutive series with a successful PTCA, irrespective of presence or absence of recurrent ischemic symptoms. Furthermore, changes in lesion severity were assessed quantitatively by an automated edge-detection technique rather than visual analysis. Employing such a study design and follow-up protocol, it was found that the incidence of restenosis in patients with stable coronary artery disease was similar to that of patients with unstable rest angina, irrespective of the type of angiographic definition used.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Grüntzig AR, Senning A, Siegenthaler WE. Nonoperative dilatation of coronary-artery stenosis. Percutaneous transluminal coronary angioplasty. N Engl J Med 1979; 301: 61–68.

    PubMed  Google Scholar 

  2. Faxon DP, Detre KM, McCabe CH, Fisher L, Holmes DR, Cowley MJ, Bourassa MG, Van Raden M, Ryan TJ. Role of percutaneous transluminal coronary angioplasty in the treatment of unstable angina. Report from the National Heart, Lung and Blood Institute Percutaneous Transluminal Coronary Angioplasty and Coronary Artery Surgery Study Registries. Am J Cardiol 1983; 53: 131C-135C.

    Google Scholar 

  3. Williams DO, Riley RS, Singh AK, Gewirtz H, Most AS. Evaluation of the role of coronary angioplasty in patients with unstable angina pectoris. Am Heart J 1981; 102: 1–9.

    PubMed  Google Scholar 

  4. Meyer J, Schmitz H-J, Kiesslich T, Erbel R, Krebs W, Schulz W, Bardos P, Minale C, Messmer BJ, Effert S. Percutaneous transluminal coronary angioplasty in patients with stable and unstable angina pectoris: analysis of early and late results. Am Heart J 1983; 106: 973–980.

    PubMed  Google Scholar 

  5. Feyter PJ de, Serruys PW, Brand M van den, Balakumaran K, Mochtar B, Soward AL, Arnold AER, Hugenholtz PG. Emergency coronary angioplasty in refractory unstable angina. N Engl J Med 1985; 313: 342–346.

    PubMed  Google Scholar 

  6. Feyter PJ de, Serruys PW, Soward A, Brand M van den, Bos E, Hugenholtz PG. Coronary angioplasty for early postinfarction unstable angina. Circulation 1986; 74: 1365–1370.

    PubMed  Google Scholar 

  7. Quigley PJ, Erwin J, Maurer BJ, Walsh MJ, Gearty GF. Percutaneous transluminal coronary angioplasty in unstable angina: comparison with stable angina. Br Heart J 1986; 55:227–230.

    PubMed  Google Scholar 

  8. Kaltenbach M, Kober G, Scherer D, Vallbracht C. Recurrence rate after successful coronary angioplasty. Eur Heart J 1985; 6: 276–281.

    PubMed  Google Scholar 

  9. Holmes Jr DR, Vlietstra RE, Smith HC, Vetrovec GW, Kent KM, Cowley MJ, Faxon DP, Grüntzig AR, Kelsey SF, Detre KM, Van Raden MJ, Mock MB. Restenosis after percutaneous transluminal coronary angioplasty (PTCA): a report from the PTCA Registry of the National Heart, Lung and Blood Institute. Am J Cardiol 1984; 53: 77C-81C.

    PubMed  Google Scholar 

  10. Leimgruber PP, Roubin GS, Hollman J, Cotsonis GA, Meier B, Douglas JS, King III SB, Gruntzig AR. Restenosis after successful coronary angioplasty in patients with single-vessel disease. Circulation 1986; 73: 710–717.

    PubMed  Google Scholar 

  11. Levine S, Ewels CJ, Rosing DR, Kent KM. Coronary angioplasty: clinical and angiographic follow-up. Am J Cardiol 1985; 55: 673–676.

    PubMed  Google Scholar 

  12. Myler RK, Topol EJ, Shaw RE, Stertzer SH, Clark DA, Fishman J, Murphy MC. Multiple vessel coronary angioplasty: Classification, results, and patterns of restenosis in 494 consective patients. Cathet Cardiovasc Diagn 1987; 13: 1–15.

    PubMed  Google Scholar 

  13. Zaidi AR, Hollman J, Galan K, Belardi J, Franco I, Simpfendorfer CC, Klein MI. Predictive value of chest discomfort for restenosis following successful coronary angioplasty. Circulation 1985; 72: III-456 (abstract).

    Google Scholar 

  14. Wijns W, Serruys PW, Reiber JHC, Feyter PJ de, Brand M van den, Simoons ML, Hugenholtz PG. Early detection of restenosis after successful percutaneous transluminal coronary angioplasty by exercise-redistribution thallium scintigraphy. Am J Cardiol 1985; 55: 357–361.

    PubMed  Google Scholar 

  15. Serruys PW, Luijten HE, Beatt KJ, Geuskens R, Feyter PJ de, Brand M van den, Reiber JHC, Katen HJ ten, Es GA van, Hugenholtz PG. Incidence of restenosis after successful coronary angioplasty: a time-related phenomenon. Circulation: 1988; 77: 361–371.

    PubMed  Google Scholar 

  16. Ross R. The pathogenesis of atherosclerosis — an update. New Engl J Med 1986; 314: 488–500.

    PubMed  Google Scholar 

  17. Dangoisse V, Guiteras Val P, David PR, Lespérance J, Crépeau J, Dyrda I, Bourassa MG. Recurrence of stenosis after successful percutaneous transluminal coronary angioplasty (PTCA). Circulation 1982; 66: II-331 (abstract).

    Google Scholar 

  18. Urban P, Meier B, Finci L, Bruyne B de, Steffenino G, Rutishauser W. Coronary wedge pressure: A predictor of restenosis after coronary balloon angioplasty. J Am Coll Cardiol 1987; 10: 504–509.

    PubMed  Google Scholar 

  19. Ernst JMPG, Feltz TA van der, Bal ET, Bogerijen L van, Berg EJM van den, Ascoop CAPL, Plokker HWM. Long term angiographic follow up, cardiac events, and survival in patients undergoing percutaneous transluminal coronary angioplasty. Br Heart J 1987; 57: 220–225.

    PubMed  Google Scholar 

  20. Forrester JS, Litvack F, Grundfest W, Hickey A. A perspective of coronary disease seen through the arteries of living man. Circulation 1987; 75: 505–513.

    PubMed  Google Scholar 

  21. Sherman CT, Litvack F, Grundfest W, Lee M, Hickey A, Chaux A, Kass R, Blanche C, Matloff J, Morgenstern L, Ganz W, Swan HJC, Forrester J. Coronary angioscopy in patients with unstable angina pectoris. N Engl J Med 1986; 315: 913–919.

    PubMed  Google Scholar 

  22. Blackburn H. Electrocardiographic classification for population comparisons. The Minnesota Code. J Electrocardiol 1969; 2: 5–10.

    PubMed  Google Scholar 

  23. Reiber JHC, Serruys PW, Kooijman CJ, Wijns W, Slager CJ, Gerbrands JJ, Schuurbiers JCH, Boer A den, Hugenholtz PG. Assessment of short-, medium-, and long-term variations in arterial dimensions from computer-assisted quantitation of coronary cineangiograms. Circulation 1985; 71: 280–288.

    PubMed  Google Scholar 

  24. Reiber JHC, Serruys PW, Kooijman CJ, Slager CJ, Schuurbiers JCH, Boer A den. Approaches towards standardization in acquisition and quantitation of arterial dimensions from cineangiograms. In: Reiber JHC, Serruys PW, eds. State of the art in quantitative coronary arteriography. Dordrecht: Martinus Nijhoff Publishers, 1986; 145–172.

    Google Scholar 

  25. Reiber JHC, Kooijman CJ, Boer A den, Serruys PW. Assessment of dimensions and image quality of coronary contrast catheters from cineangiograms. Cathet Cardiovasc Diagn 1985; 11: 521–531.

    PubMed  Google Scholar 

  26. Wijns W, Serruys PW, Reiber JHC, Brand M van den, Simoons ML, Kooijman CJ, Balakumaran K, Hugenholtz PG. Quantitative angiography of the left anterior descending coronary artery: correlations with pressure gradient and results of exercise thallium scintigraphy. Circulation 1985; 71: 273–279.

    PubMed  Google Scholar 

  27. Serruys PW, Reiber JHC, Wijns W, Brand M van den, Kooijman CJ, Katen HJ ten, Hugenholtz PG. Assessment of percutaneous transluminal coronary angioplasty by quantitative coronary angiography: diameter versus densitometric area measurements. Am J Cardiol 1984; 54: 482–488.

    PubMed  Google Scholar 

  28. Kooijman CJ, Reiber JHC, Gerbrands JJ, Schuurbiers JCH, Slager CJ, Boer A den, Serruys PW. Computer-aided quantitation of the severity of coronary obstructions from single view cineangiograms. First IEEE Computer Society International Symposium on Medical Imaging and Image Interpretation. IEEE Cat No 82 CH1804-4 1982; 59–64.

  29. Austen WG, Edwards JE, Frye RL, Gensini GG, Gott VL, Griffith LSC, McGoon DC, Murphy ML, Roe BB. A reporting system in patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation 1975; 51: 7–40.

    Google Scholar 

  30. Fuster V, Frye RL, Connolly DC, Danielson MA, Elveback LR, Kurland LT. Arteriographic patterns early in the onset of the coronary syndromes. Br Heart J 1975; 37: 1250–1255.

    PubMed  Google Scholar 

  31. Alison HW, Russell Jr RO, Mantle JA, Kouchoukos NT, Moraski RE, Rackley CE. Coronary anatomy and arteriography in patients with unstable angina pectoris. Am J Cardiol 1978; 41: 204–209.

    PubMed  Google Scholar 

  32. Rafflenbeul W, Smith LR, Rogers WJ, Mantle JA, Rackley CE, Russell Jr RO. Quantitative coronary arteriography: coronary anatomy of patients with unstable angina pectoris reexamined 1 year after optimal medical therapy. Am J Cardiol 1979; 43: 699–707.

    PubMed  Google Scholar 

  33. Falk E. Plaque rupture with severe pre-existing stenosis precipitating coronary thrombosis. Characteristics of coronary artherosclerotic plaques underlying fatal occlusive thrombi. Br Heart J 1983; 50: 127–134.

    PubMed  Google Scholar 

  34. Falk E. Unstable angina with fatal outcome: dynamic coronary thrombosis leading to infarction and/or sudden death. Autopsy evidence of recurrent mural thrombosis with peripheral embolization culminating in total vascular occlusion. Circulation 1985; 71: 699–708.

    PubMed  Google Scholar 

  35. Davies MJ, Thomas A. Thrombosis and acute coronaryartery lesions in sudden cardiac ischemic death. N Engl J Med 1984; 310: 1137–1140.

    PubMed  Google Scholar 

  36. Levin DC, Fallon JT. Significance of the angiographic morphology of localized coronary stenoses. Histopathologic correlations. Circulation 1982; 66: 316–320.

    Google Scholar 

  37. Ambrose JA, Winters SL, Stern A, Eng A, Teichholz LE, Gorlin R, Fuster V. Angiographic morphology and the pathogenesis of unstable angina pectoris. J Am Coll Cardiol 1985; 5: 609–616.

    PubMed  Google Scholar 

  38. Gorlin R, Fuster V, Ambrose JA. Anatomic-physiologic link between acute coronary syndromes. Circulation 1986; 74: 6–9.

    PubMed  Google Scholar 

  39. Maseri A, L'Abbate A, Baroldi G, Chierchia S, Marzilli M, Ballestra AM, Severi S, Parodi O, Biagini A, Distante A, Pesola A. Coronary vasospasm as a possible cause of myocardial infarction: a conclusion derived from the study of ‘preinfarction’ angina. N Engl J Med 1978; 299: 1271–1277.

    PubMed  Google Scholar 

  40. Detre KM, Kelsey SF, Passamani ER, Fisher MR, Brensike JF, Battaglini JW, Richardson JM, Loh IK, Stone NJ, Aldrich RF, Levy RI, Epstein SE. Reliability of assessing change with sequential coronary angiography. Am Heart J 1982; 104: 816–823.

    PubMed  Google Scholar 

  41. Vandormael MG, Deligonul U, Kern MJ, Harper M, Presant S, Gibson P, Galan K, Chaitman BR. Multilesion coronary angioplasty: Clinical and angiographic follow-up. J Am Coll Cardiol 1987; 10: 246–252.

    PubMed  Google Scholar 

  42. Fleiss JL. Statisticalmethods for rates and proportions. New York: John Wiley & Sons, 1973: 23.

    Google Scholar 

  43. Gruentzig AR, King III SB, Schlumpf M, Siegenthaler W. Long-term follow-up after percutaneous transluminal coronary angioplasty. N Engl J Med 1987; 316: 1127–1132.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Catheterization Laboratory, University Hospital Dijkzigt, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands

    P. W. Serruys MD (FACC)

Authors
  1. Hans E. Luijten
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. J. Beatt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. J. de Feyter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. van den Brand
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. H. C. Reiber
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. W. Serruys MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

H.E. Luijten, MD, is the recipient of a Research Fellowship from the Dutch Heart Foundation (no. 85–118).

K.J. Beatt, MD, MRCP, is the recipient of a Research Fellowship from the British and Dtuch Heart Foundations.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Luijten, H.E., Beatt, K.J., de Feyter, P.J. et al. Angioplasty for stable versus unstable angina pectoris: Are unstable patients more likely to get restenosis?. Int J Cardiac Imag 3, 87–97 (1988). https://doi.org/10.1007/BF01814881

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01814881

Key words

Search

Navigation