Clinical and quantitative coronary angiographic predictors of coronary restenosis: a comparative analysis from the balloon-to-stent era
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Published on: May 14, 2013
N Mercado1, E Boersma, W Wijns
1Thoraxcenter, University Hospital Dijkzigt, Rotterdam, The Netherlands.
Insights
Coronary stents significantly reduced restenosis rates compared to percutaneous transluminal coronary angioplasty alone. While demographic and clinical predictors remain similar, achieving an optimal post-procedural result is crucial for favorable outcomes in the stent era.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Clinical Trials and Registries
Background:
- Systematic analysis of percutaneous transluminal coronary angioplasty (PTCA) and stent era predictors of restenosis is lacking.
- Large-scale data from registries and randomized trials are needed to compare revascularization techniques.
Purpose of the Study:
- To assess if coronary stents alter the predictive value of demographic, clinical, and quantitative coronary angiographic (QCA) factors for coronary restenosis.
- To identify predictors of restenosis specific to PTCA versus stenting.
Main Methods:
- Analysis of 9,120 lesions in 8,156 patients from nine randomized trials and 10 registries.
- Inclusion of baseline, post-procedural, and six-month follow-up QCA data.
- Univariate and multivariate logistic regression with interaction terms to compare PTCA and stent eras.
Main Results:
- Restenosis rates were 35% after PTCA and 19% after stenting.
- Favorable predictors included stent use, previous CABG, and large post-procedural minimal lumen diameter (post-MLD).
- Unfavorable predictors included lesion length and diabetes mellitus; severe pre-procedural diameter stenosis (pre-DS) was no longer unfavorable in the stent era.
Conclusions:
- Demographic and clinical predictors of restenosis show minimal differences between PTCA and stent populations.
- A large post-MLD is a critical favorable predictor, especially in the stent era.
- A large pre-procedural reference diameter (pre-RD) emerged as a favorable predictor with stenting.
Objectives:
We sought to assess whether coronary stents have modified the predictive value of demographic, clinical and quantitative coronary angiographic (QCA) predictors of coronary restenosis.
Background:
A systematic analysis in a large cohort of registries and randomized trials of the percutaneous transluminal coronary angioplasty (PTCA) and stent era has never been performed.
Methods:
A total of 9,120 treated lesions in 8,156 patients included in nine randomized trials and 10 registries, with baseline, post-procedural and six-month follow-up QCA analyses, were included in this study. Predictors of restenosis were identified with univariate and multivariate logistic regression analyses. Interaction terms were introduced in the regression equation to evaluate whether the predictors of restenosis were common to both eras or specific for either one of the revascularization techniques.
Results:
The restenosis rate was 35% after PTCA and 19% after angioplasty with additional stenting. In the univariate analysis, favorable predictors were previous coronary artery bypass graft surgery (CABG), stent use, stent length and a large pre-procedural minimal lumen diameter (pre-MLD); unfavorable predictors were weight, body mass index, diabetes mellitus, multi-vessel disease, lesion length and a high residual post-procedural diameter stenosis (post-DS). Predictors specific for the PTCA population were a large post-procedural MLD (post-MLD) as favorable and a severe pre-procedural DS (pre-DS) as unfavorable. Favorable predictors specific for the stent population were a large post-MLD and a large pre-procedural reference diameter (pre-RD). In the multivariate analysis, the best model included the following favorable predictors: stent use, a large post-MLD, previous CABG and the interaction term between stent use and a large post-MLD; unfavorable predictors were lesion length and diabetes mellitus.
Conclusions:
There are no major differences in demographic and clinical predictors of coronary restenosis between PTCA and stent populations. In the modern (stent) era, a severe pre-DS is no longer an unfavorable predictor of restenosis. Still important, but more so in the stent population, is a large post-MLD (optimal result). Finally, a larger pre-RD became a favorable predictor with the advent of stenting.
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