The risk for subsequent coronary interventions in a local Polish population

Introduction: Paradoxically, the literature lacks an assessment of the impact of various factors on subsequent coronary interventions in patients with coronary artery disease (CAD).Aim: To assess the impact of various factors on subsequent percutaneous transluminal coronary angioplasty (PTCA), as well as to characterize the clinical profile of people undergoing repeated diagnostic coronary angiography without significant coronary artery changes. Material and methods:We investigated retrospective data from 4041 subjects according to the clinical factors which may affect the occurrence of unplanned future PTCA.Results: The strongest risk factors for subsequent PTCA were significant stenosis of left descending artery (OR = 2.17, 95% CI: 1.09-4.32)during baseline coronary angiography, the atherosclerotic burden (number of critically narrowed vessels) (OR for narrowing lesions in 3 epicardial arteries 12.13, 95% CI: 5.40-27.27),and restenosis in a previously implanted stent (OR = 4.34, 95% CI: 1.96-9.62).A strong positive relationship between total mortality and the number of critically narrowed coronary arteries (during baseline hospitalization) was observed.Patients without significant coronary artery stenosis in two diagnostic angiographies (control group) differed from subjects with hemodynamic relevant CAD in: higher creatinine levels, more frequent presence of chronic obstructive pulmonary disease and more frequent symptoms of intermittent claudication. Conclusions:The results of the study are in accord with real clinical practice.The arteriosclerotic burden is a major cause of recurrent PTCA, but an important clinical issue is the qualification for recurrent coronary-angiography in those patients whose previous coronary angiography did not show significant stenosis, because other clinical causes may explain their symptoms. Key words: subsequent percutaneous transluminal coronary angioplasty, coronary artery disease, ischemic heart disease. S u m m a r yThe available literature lacks an assessment of the impact of various factors on subsequent coronary interventions in patients with coronary artery disease (CAD).We found that the strongest risk factors for subsequent percutaneous transluminal coronary angioplasty in our analysis were significant narrowed left descending artery, restenosis in a previously implanted stent, and atherosclerotic burden.Only a few reports are available concerning characterizing the clinical profile of patients undergoing diagnostic coronary angiographies on several occasions with no significant changes in the lumen of the coronary arteries.Patients with symptoms suggestive of angina without significant coronary artery stenosis in angiography differed from patients with CAD in our study by higher creatinine levels, more frequent presence of chronic obstructive pulmonary disease and more frequent symptoms of intermittent claudication.

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