Recurrent ischemia after percutaneous coronary intervention
Abstract
Aim. To study the incidence, time of development, and the main causes of recurrent myocardial ischemia after effective revascularization and percutaneous coronary intervention (PCI).
Material and methods. The study included 108 patients PCI with coronary artery (CA) stenting (85 men (78,7 %), 23 women (21,3 %)), who were followed for two years. All participants underwent clinical examination, blood biochemistry, electrocardiography (ECG), 24-hour ECG monitoring, stress echocardiography (EchoCG), and coronary angiography (CAG).
Results. After PCI, favorable clinical course of coronary heart disease (CHD) was observed in 72 patients (66,7 %), while recurrent ischemia or a reduction in FC of effort angina was registered in 36 (33,3 %). Among women, recurrent or persistent ischemia was more prevalent than among men: 13 (56,5 %) vs. 23 (27 %) cases (p=0,015). Positive test stress EchoCG was observed in 30 patients. Based on the repeat CAG results, recurrent ischemia was due to incomplete myocardial revascularization (n=15), in-stent restenosis (n=12), or atherosclerosis progression (n=10).
Conclusion. Active clinical examination is recommended to all patients after PCI, especially women. Stress EchoCG is recommended within first 9 months after PCI for angina-free patients and at any time for patients with recurrent angina.
About the Authors
M. P. Malgina
V.A. Almazov Federal Centre of Heart, Blood, and Endocrinology
Russian Federation
St. Petersburg
Russian Federation
St. Petersburg
A. O. Nedoshivin
V.A. Almazov Federal Centre of Heart, Blood, and Endocrinology
Russian Federation
St. Petersburg
Russian Federation
St. Petersburg
B. B. Bondarenko
V.A. Almazov Federal Centre of Heart, Blood, and Endocrinology
Russian Federation
St. Petersburg
Russian Federation
St. Petersburg
References
1. Беленков Ю.Н., Батыралиев Т.А., Першуков И.В. Инвазивная кардиология — фокус на рестеноз. Часть 1. Кардиология 2002; 42(8): 50-6.
2. Беленков Ю.Н., Батыралиев Т.А., Першуков И.В. и др. Инвазивная кардиология — фокус на рестеноз. Часть 2. Кардиология 2002; 42(11): 68-72.
3. Беленков Ю.Н., Матчин Ю.Г., Лякишев А.А. и др. Применение стентов с лекарственным покрытием сиролимусом “Cypher” у больных ишемической болезнью сердца с разными типами поражения коронарных артерий. Вест рентген радиол 2006; 3: 4-12.
4. Беленков Ю.Н., Самко А.Н., Батыралиев Т.А. и др. Коронарная ангиопластика: взгляд через 30 лет. Кардиология 2007; 9.
5. Бокерия Л.А., Гудкова Р.Г. Сердечно-сосудистая хирургия-2006. М., НЦССХ 2007.
6. Abbate A, Giuseppe GL, Biondi-Zoccai, et al. Recurrent angina after coronary revascularization: a clinical challenge. Eur Heart J 2007; 28: 1057-65.
7. Colombo A, Iakovou I. Drug-eluting stents: the new gold standard for percutaneous coronary revascularization. Eur Heart J 2004; 25: 895-7.
8. Damirin A, Tomura H, Komachi M, et al. Role of lipoproteinassociated lysophospholipids in migratory activity of coronary artery smooth muscle cells. Am J Physiol Heart Circ Physiol 2007; 292 (Suppl.5): H2513- 22.
9. Gibbons RJ, Balady GJ, Bricker JT, et al. ACC/AHA 2002 guideline update for exercise testing — summary article: a report of the American College of Cardiology/American Heart Association task force of practice guidelines (Committee to update the 1997 exercise testing guidelines). Circulation 2002; 106: 1883-92.
10. Jacobs AK. Women, ischemic heart disease, revascularization and the gender gap. What are we missing? JACC 2006; 47(3): 63S-5.
11. Jensen J, Lagerqvist B, Aasa M, et al. Clinical and angiographic follow-up after coronary drug-eluting and bare metal stent implantation. Do drug-eluting stents hold the promise? J Intern Med 2006; 260 (2): 118-24.
12. Jeremias A, Kutscher S, Haude M, et al. Non-ischemic chest pain induced by coronary interventions: a prospective study comparing angioplasty and stent implation. Circulation 1998; 98: 2656-8.
13. Kastrati A, Mehilli J, von Beckerath N, et al. Sirolimuseluting stent or paclitaxel-eluting stent vs balloon angioplasty for prevention of recurrences in patients with coronary in-stent restenosis: a randomized controlled trial. JAMA 2005; 293 (Suppl.2): 165-71.
14. Komatsu R, Ueda M, Naruko T, et al. Neointimal tissue response at sites of coronary stenting in humans: macroscopic, histological, and immunohistochemical analyses. Circulation 1998; 98 (Suppl.3): 224-33.
15. Lemos PA, Hoye A, Serruys PW. Recurrent angina after revascularization: an emerging problem for the clinician. Coron Artery Dis 2004; 15 (Suppl.1): 11-5.
16. Mehran R, Dangas G, Abizaid AS, et al. Angiographic patterns of in-stent restenosis. classification and implications for longterm outcome. Circulation 1999; 2: 1872-8.
17. Pasceri V, Patti G, Maseri A. Changing features of anginal pain after PTCA suggest a stenosis on a different artery rather than restenosis. Circulation 1997; 96: 3278-80.
18. Presbitero P, Carcagnì A. Gender differences in the outcome of interventional cardiac procedures. Ital Heart J 2003; 4(Suppl.8): 522-7.
19. Silber S, Albertsson P, Aviles F, et al. Guidelines for percutaneous coronary intervention. The task force for percutaneous coronary interventions of the European society of cardiology. Eur Heart J 2005; 26(8): 804-47.
20. Smith S, Feldman T, Hirshfekl J, et al. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention. A report of the American Cardiology/American Heart Association task force on practice guidelines (ACC/AHA/SCAI writing committee to update the 2001 Guidelines for percutaneous coronary intervention). Circulation 2006; 113 (7): 166-286.
21. Smith SC Jr, Allen J, Blair SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung, and Blood Institute. Circulation 2006; 113(Suppl.19): 2363-72.
22. Topakian R, Sonnberger M, Nussbaumer K, et al. Postprocedural high-density lipoprotein cholesterol predicts carotid stent patency at 1 year. Eur J Neurol 2008; 15(Suppl.2): 179-84.
23. Trabattoni D, Fabbiocchi F, Montorsi P, et al. Angiographic patterns of in-stent restenosis in men and women. Ital Heart J 2005; 6(Suppl.2): 138-42.
Review
For citations:
Malgina M.P., Nedoshivin A.O., Bondarenko B.B. Recurrent ischemia after percutaneous coronary intervention. Cardiovascular Therapy and Prevention. 2011;10(7):18-22. (In Russ.)
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