Clinical and Angiographic Factors Associated With Asymptomatic Restenosis After Percutaneous Coronary Intervention

Abstract

Background Angiographic restenosis after percutaneous coronary interventional procedures is more common than recurrent angina. Clinical and angiographic factors associated with asymptomatic versus symptomatic restenosis after percutaneous coronary intervention were compared. Methods and Results All patients with angiographic restenosis from the BENESTENT I, BENESTENT II pilot, BENESTENT II, MUSIC, WEST 1, DUET, FINESS 2, FLARE, SOPHOS, and ROSE studies were analyzed. Multivariate analysis evaluated 46 clinical and angiographic variables, comparing those with and without angina. The 10 studies recruited 2690 patients who underwent percutaneous revascularization and 6-month follow-up angiography (86% of those eligible). Restenosis (≥50% diameter stenosis) occurred in 607 patients and was clinically silent in 335 (55%). Male sex ( P =0.008), absence of antianginal therapy with nitrates ( P =0.0002) and calcium channel blockers ( P =0.02) at 6 months, greater reference diameter after the procedure ( P =0.04), greater reference diameter at follow-up ( P =0.004), and lesser lesion severity (percent stenosis) at 6 months ( P =0.0004) were univariate predictors of asymptomatic restenosis. By multivariate analysis, only male sex ( P =0.04), greater reference diameter at follow-up ( P =0.002), and lesser lesion severity at 6 months ( P =0.0001) were associated with restenosis without angina. Conclusions Approximately half of patients with angiographic restenosis have no symptoms. The only multivariate predictors of silent restenosis at 6 months were male sex, greater reference diameter at follow-up, and lesser lesion severity on follow-up angiography.