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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Association of stent diameter and target vessel revascularization in patients undergoing percutaneous coronary
Tiancheng Xu1,2, Beili Feng1,2, Zaixing Zheng1,2
1Department of Cardiology, Hwa Mei Hospital, University of Chinese Academy of Sciences, No. 41 Northwest Street, Haishu District, Ningbo, 315000, Zhejiang, China.
Insights
Larger stent diameter is a protective factor against target vessel revascularization (TVR) in patients undergoing percutaneous coronary intervention (PCI). This "bigger-is-better" effect is most pronounced with stent diameters between 2.5 and 2.9 mm.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomedical Engineering
Background:
- Coronary heart disease (CHD) management increasingly utilizes percutaneous coronary intervention (PCI).
- Target vessel revascularization (TVR) is a critical endpoint following PCI.
- Optimizing stent selection is crucial for improving PCI outcomes.
Purpose of the Study:
- To investigate the relationship between stent diameter and the occurrence of TVR in patients who underwent PCI.
- To determine if stent diameter influences the need for repeat revascularization procedures.
Main Methods:
- Retrospective analysis of 2522 patients with implanted stents from the Dryad Digital Repository.
- Utilized multivariable logistic regression, interaction, subgroup, and piecewise linear regression models.
- Evaluated the association between continuous and categorical stent diameter measurements and TVR.
Main Results:
- A total of 122 patients (4.8%) experienced TVR.
- Larger stent diameter was significantly associated with a lower risk of TVR (OR 0.526, 95% CI 0.306-0.902).
- This protective effect was particularly strong in the delayed PCI subgroup and for stent diameters ranging from 2.5 to 2.9 mm.
Conclusions:
- Increased stent diameter serves as a significant protective factor against TVR following PCI.
- The "bigger-is-better" phenomenon is evident, especially within the 2.5-2.9 mm stent diameter range.
- Stent diameter is an important consideration for optimizing long-term outcomes in PCI patients.
Background:
In the treatment of coronary heart disease, target vessel revascularization (TVR) has attracted increasing attention as an efficient means of percutaneous coronary intervention (PCI). The purpose of this study was to explore the association between stent diameter and TVR in patients undergoing PCI.
Methods:
This was a secondary retrospective analysis involving patients with PCI with at least one stent implanted. Information was obtained from the Dryad Digital Repository. Multivariable logistic regression models, interaction analyses, subgroup analyses and piecewise linear regression models were used to evaluate the association between stent diameter and TVR.
Results:
A total of 2522 patients were eventually enrolled in this study, of which 122 (4.8%) had undergone TVR. Significant positive associations were observed between stent diameter and TVR (continuous: odds ratio [OR] 0.485, 95% confidence interval [CI] 0.305-0.773, P = 0.002; categorical variable: T2 vs. T1, OR 0.541, 95% CI 0.348-0.843; T3 vs. T1, OR 0.520, 95% CI 0.334-0.809; P for trend = 0.005). The association remained stable in the fully adjusted model (continuous: OR 0.526, 95% CI 0.306-0.902, P = 0.020; categorical variable: T2 vs. T1, OR 0.510, 95% CI 0.310-0.839; T3 vs. T1, OR 0.585, 95% CI 0.352-0.973; P for trend = 0.042). Among the subgroups of differing clinical presentations, stent diameter was a powerful protective factor for TVR, especially in the delayed PCI group (P for interaction = 0.002). The association was highly consistent across all the other subgroups studied (all P for interaction > 0.05). In the piecewise linear regression model, the need for TVR decreased with an increase in stent diameter when this ranged between 2.5 and 2.9 mm (OR 0.01, 95% CI: 0.01-0.13, P < 0.001).
Conclusions:
A large stent diameter is a powerful protective factor for TVR in PCI patients, especially in the delayed PCI group. This "bigger-is-better" protective effect is remarkable in stents with diameter 2.5-2.9 mm.
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