Usefulness of repeat coronary angiography 24 hours after successful balloon angioplasty to evaluate early luminal deterioration and facilitate quantitative analysis

Because of the unavoidable occurrence of vessel disruption after successful coronary balloon angioplasty, the reliability of quantitative angiographic analysis in that setting has been questioned. For this reason and the suggested occurrence of delayed elastic recoil, repeat angiography at 24 hours...

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Published in:	The American journal of cardiology Vol. 72; no. 18; pp. 1341 - 1347
Main Authors:	Foley, David P., Deckers, Jaap, van den Bos, Arjan A., Heyndrickx, Guy R., Laarman, Gert-Jan, Suryapranata, Harryanto, Zijlstra, Felix, Serruys, Patrick W.
Format:	Journal Article
Language:	English
Published:	New York, NY Elsevier Inc 15-12-1993 Elsevier Elsevier Limited
Subjects:	Adult Aged Angioplasty Angioplasty, Balloon, Coronary Biological and medical sciences Cardiovascular disease Confounding Factors (Epidemiology) Coronary Angiography Coronary Disease - diagnostic imaging Coronary Disease - physiopathology Coronary Disease - therapy Coronary vessels Diseases of the cardiovascular system Elasticity Female Humans Linear Models Male Medical imaging Medical research Medical sciences Middle Aged Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Time Factors Treatment Outcome Human Measurement Light Coronary artery Radiologic investigation Instrumentation therapy Instrumental dilatation Diameter Quantitative analysis Angiocardiography
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Summary:	Because of the unavoidable occurrence of vessel disruption after successful coronary balloon angioplasty, the reliability of quantitative angiographic analysis in that setting has been questioned. For this reason and the suggested occurrence of delayed elastic recoil, repeat angiography at 24 hours has been advocated in clinical interventional trials. In this study, these issues are confronted by performing comprehensive quantitative analysis (Cardiovascular Angiographic Analysis System) of coronary angiograms, acquired in multiple identical projections immediately after and 24 hours after angioplasty, in 102 patients with 110 successfully dilated lesions. Vasomotion was controlled by intracoronary nitrate before angiography and all patients were fully anticoagulated (activated partial thromboplastin time 85 to 120 seconds) for >24 hours. Paired Student's (tests applied to angiographic measurements revealed that there was no significant deterioration in minimal luminal diameter or cross-sectional area from immediately after angioplasty to 24 hours later. It can thus be inferred that there is no phenomenon of delayed elastic recoil, at least during this time period. Measurement accuracy and precision of the Cardiovascular Angiographic Analysis System from the postangioplasty angiogram are highly acceptable, at < 0.01 and ± 0.20 mm, respectively. Therefore, it is concluded that routine repeat 24-hour angiography is not indicated after successful angioplasty. A highly significant increase (p < 0.001) in reference diameter (+0.11 ± 0.18 mm) was responsible for the apparent increase in percent diameter stenosis (2.4 ± 7%), a finding that demonstrates the potential for error by selective application of percent diameter stenosis measurements atone. Preferential use of absolute luminal measurements is thus strongly recommended for clinical trials with angiographic monitoring.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0002-9149 1879-1913
DOI:	10.1016/0002-9149(93)90176-D