Increased frequency of restenosis in patients continuing to smoke cigarettes after percutaneous transluminal coronary angioplasty.

The influence of continued cigarette smoking on restenosis after percutaneous transluminal coronary angioplasty (PTCA) was retrospectively determined through a study of 160 patients with primary success who underwent follow-up angiography after a mean of 7 +/- 7 months. The average number of narrowings at risk for restenosis was 1.7/patient in the 84 patients who continued to smoke (group 1) and 1.9/patient in the 76 patients who stopped smoking at the time of PTCA (group 2) (difference not significant). The 2 patient groups at baseline were similar with respect to gender, frequency of diabetes mellitus, number of pack/year smoking, angina class and number of diseased coronary arteries. The location of the dilated narrowings, the residual luminal diameter stenosis and the transstenotic gradient after the procedure were similar in both groups. The recurrence of angina greater than or equal to class II was the reason for restudy in 43% and 36% of group 1 and group 2 patients, respectively. Restenosis, defined as the presence of greater than or equal to 50% narrowing at the site of previous successful dilatation at follow-up angiography, was significantly higher in group 1 compared with group 2 patients (55% vs 38%, p = 0.03). Continued smoking was selected as an independent predictor of restenosis by logistic regression analysis. The incidence of coronary artery disease progression (14% vs 10%) was not significantly different between the 2 groups. In conclusion, continued smoking after successful PTCA is associated with an increased risk of restenosis. The higher restenosis rate in smokers emphasizes the need to strengthen educational programs after PTCA.

Recurrence of stenoses after coronary angioplasty.

Recurrence remains a major problem after PTCA. The recurrence rate is higher in patients with diabetes, patients 70 years of age or older, and patients with severe coronary artery disease. Intimal tearing during the procedure may lower the recurrence rate. Recurrence in patients with multivessel angioplasty is higher than for those with single-vessel angioplasty, and it appears to be cumulative. The nurse can play an important role in risk-factor modification, teaching, and promoting smooth transitions in life-style changes after patients undergo angioplasty. Through education by the nurse, patients can learn to recognize angina and learn how to seek treatment for recurrence of ischemic symptoms. Lastly, the nurse can play an important role in patient follow-up. This can be done by reinforcing and encouraging patient compliance. Through further research the management and control of recurrence can be better understood.

Significance of early chest pain after coronary angioplasty.

In summary, coronary angioplasty has proved to be an alternative to bypass surgery in relieving angina in selected patients. Unfortunately, some patients experience early transient chest pain during their hospitalization. Early prolonged chest pain with electrocardiographic changes requires nursing attention because it may represent an acute complication of PTCA requiring immediate medical intervention.