Effect Of Clinical And Angiographic Characteristics On Cardiac Event After Percataneous Coronary Intervention

PrefacePercutaneous coronary intervention(PCI) is now a well - accepted revascularization procedure for coronary antery disease (CAD) , it includes percutaneous transruminal coronary angioplasty ( PTCA) and coronary stent placement. Balloon coronary angioplasty is currendy supplemented by placemnt of stents in>70% of case.Restenosis after successful PCI represents an importance problem affecting an increasing number of patiens. Clinical and sequential angiographic fellow - up becomes importance method used to study whether have restenosis and CAD progression. But in our country, sequential angiographic fellow - up rate is low, the end point in most trials is candiac event. This trials'objective is studying effection of clinical and angiographic characteristics on cardiac event after PCI.Methods1. PatientsThis study includes a consecutive series of 120 patients with CAD who underwent PCI from January 2001 to May 2002.2. Procedure and angiographic assessmentIn all patients, the procedures were performed by means of the femoral approach. Using standard techniques. All patients receivedhaparin at the time of the procedure to achieve an activated clotting time (ACT)>300s. After the procedure, patients received aspirin and ticlopidine.Quantitative coronary angiography analysis was performed. The angiographic parameters obtained were minimal lumen diameter (MLD) before PCI, diameter stenosis, lesion length , maximal balloon pressure,and ACC/AHA classification.3. Follow-upPatients' clinical and angiographic baseline characteristics were recorded, clinical end point was cardiac events included ; death, angina, myocardial infarction (MI) , repeat coronary angioplasty and coronary bypass surgery(CABG).4. Statistical analysisVariance analysis were perfomed by SPSS 10. 0 statistical software. Event - free survival was estimated using Kaplan - Meier analysis. The contribution to outcome of several clinical, angiographic variables was evaluated by Logistic analysis. Values of p<0.05 were considered significant.Result1. Baseline characteristics of patients:The baseline characteristics of the 102 consecative patients entered this study. Followed up a mean of 9.0+3.6 months.2. Cardiac event:Total 29 patients suffered from cardiac event; death occurred in 1 patient(1.0%), angina occurred in 19 patients (18.6%), MI occurred in 4 patients(3.9%), repeat coronary angioplasty occurred in3 patients(2.9% ) , CABG occurred in 2 patients(2.0%).3. Effective factors of clinical and angiographic characteristics on cardiac event after PCIThe consecutive patients were assigned to two groups; occurred cardiac event group and none cardiac event group . There was no significant difference between two groups in age, men, current smokers, hypertension, diabetes and lipoid (P>0.05). MI before PCI was higher in cardiac event group ( P<0.05 ). There was significant difference between two groups in multivessel CAD(48. 3% vs 16.4% ) ,lesion length (16. 5+3.4mm vs 11.7+4.2mm) ,baseline MLD(0.2+ 0.2mm vs 0.5+0. 3mm) and ACC/AHA C-type lesion(48.2% vs 18.8%).4. Event - free survival and independent risk factors.1 year event - free rate was lower in multivessel CAD patients . Multivariate models for cardiac event demonstrated that multivessel CAD, long lesion ( >15mm) and MI before PCI were independent risk factors.DiscussionThe present study analyzed the outcome among patients undergoing PCI. We found PCI is an effective, safety means of revasculariza-tion in most of CAD patients. During one year follow - up , only fewer patients arrived clinical, end points. Cardiac event rate was 28. 4% , similar results (26%) were reported by other studies. The cause of cardiac event included restenosis and CAD progression.In clinical factors, the present study found no significant difference in with and without cardiac event groups on age, gender, smok-er, hypertension and diabetes mellitus. These factors'effection on outcome after PCI had different conc...