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Stented segment length as an independent predictor of restenosis
Y Kobayashi1, J De Gregorio, N Kobayashi
1Centro Cuore Columbus, Milan, Italy.
Insights
Longer coronary stents increase the risk of restenosis, but do not affect subacute stent thrombosis. Longer stented segments are independent predictors of restenosis.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomedical Engineering
Background:
- Coronary stenting is increasingly used for long or tandem lesions.
- The relationship between stented segment length and restenosis requires further investigation.
Purpose of the Study:
- To evaluate the association between the length of the stented segment and the incidence of restenosis.
- To determine if stented segment length influences subacute stent thrombosis.
Main Methods:
- A prospective study of 725 patients (1,090 lesions) between April 1995 and December 1996.
- Patients were categorized into three groups based on stented segment length: ≤20 mm, >20 to ≤35 mm, and >35 mm.
- Outcomes including minimal lumen diameter and restenosis rates were assessed at follow-up.
Main Results:
- Restenosis rates increased significantly with longer stented segments (23.9% vs. 34.6% vs. 47.2%; p < 0.01).
- A longer stented segment was an independent predictor of restenosis.
- No significant difference in subacute stent thrombosis was observed across groups.
Conclusions:
- Increased stented segment length is a significant independent predictor of restenosis.
- Stented segment length does not appear to impact the risk of subacute stent thrombosis.
Objectives:
We sought to evaluate the relation between stented segment length and restenosis.
Background:
Multiple or long coronary stents are now being implanted in long lesions or in tandem lesions. A longer stented segment might result in a higher probability of restenosis. However, there is little information available on the relation between stented segment length and restenosis.
Methods:
Between April 1995 and December 1996, 725 patients with 1,090 lesions underwent stenting. Lesions were divided into three groups according to the length of the stented segment: 1) group I (n = 565): stented segment length < or =20 mm; 2) group II (n = 278): stented segment length >20 but < or =35 mm; and 3) group III (n = 247): stented segment length >35 mm.
Results:
There was no significant difference in the incidence of subacute stent thrombosis among the three groups (0.4% in group I, 0.4% in group II, 1.2% in group III; p = NS). The minimal lumen diameter (MLD) after stenting was greater in group I than in group III (3.04 +/- 0.60 mm in group I, 3.01 +/- 0.54 mm in group II, 2.91 +/- 0.58 mm in group III; p < 0.05). At follow up, a smaller MLD was observed in group III as compared with group I and group II (2.04 +/- 0.93 mm in group I, 1.92 +/- 1.00 mm in group II, 1.47 +/- 0.97 mm in group III; p < 0.01). The restenosis rates were 23.9% in group I, 34.6% in group II and 47.2% in group III (p < 0.01). Using multivariate analysis, the longer stented segment, the angiographic reference vessel diameter and the percent diameter stenosis after stenting were independent predictors of restenosis.
Conclusions:
The present study shows that a longer stented segment is an independent predictor of restenosis without an influence on the risk of subacute thrombosis.