The effects of alcohol consumption on recurrent ischemic events after percutaneous transluminal coronary interventions

The effects of alcohol consumption on recurrent ischemic events after percutaneous transluminal coronary interventions

Journal Article

2000

Heart

83

SUPPL. 2

-

2000

13556037 (ISSN)

BACKGROUND: Restenosis following successful percutaneous transluminal coronary intervention (PTCI) remains a clinical problem. Mechanisms of restenosis are multifactorial, and include thrombus formation and intimal proliferation. Strategies directed to reduce the likelihood of coronary restenosis include oral aspirin, other antiplatelet agents, anti-lipid, and vasodilator agents. A recent report demonstrated reduced rates of restenosis following administration of the anti-oxidant, Probucol. Alcoholic beverages, particularly red wine, offer chemical properties that may effect a benefit in preventing restenosis following PTCI. Alcoholic beverages have been shown to inhibit platelet adhesion, and enhance the antiplatelet effects of oral aspirin. Alcohol consumption has been associated with an increased prostacycline/thromboxane ratio, increased endogenous tissue-type plasminogen activator, and lower levels of fibrinogen. High Density Lipoprotein (HDL-C) sub-fractions are increased, and an improved lipid phenotype may improve dysfunctional endothelial physiology in patients with atherosclerotic vascular disease. Phenolic compounds in red wine increase serum antioxidant capacity and inhibit oxidation of Low Density Lipoprotein (LDL-C). METHODS: 437 consecutive charts were reviewed from the interventional laboratory at Northwest Medical Center, a community hospital. 247 patients were contacted by telephone and completed a detailed telephone interview. In some cases, hospital records were reviewed to confirm reported information. Of these patients 106 (43%) underwent balloon angioplasty alone, 141 (57%) underwent balloon angioplasy with stent placement. Alcohol consumption in the form of wine, beer, and spirits was surveyed, as was other historical data. Survey results, specifically alcohol consumption following PTCI, were analyzed against follow-up events. A follow-up event was defined as a repeat hospitalization with unstable angina, myocardial infarction, death, angiographic restenosis, repeat PTCI to the reference lesion, or coronary bypass graft surgery. The mean follow-up was 68 weeks (range 42-126 weeks). The presence of confounding variables, such as tobacco use, vitamin and anti-oxidant use, and others, were recorded. RESULTS: 157 patients (64%) reported no alcohol use, 90 patients (36%) reported alcohol consumption following PTCI. Non-drinkers experienced 22 follow-up events whereas only 3 follow-up events were seen in patient group reporting alcohol consumption after PTCI. A chi-square test for the independence of alcohol consumption and follow-up events indicates a statistically significant dependence between the two (0.025