Predictive factors for ischemic target vessel revascularization in the Prevention of Restenosis with Tranilast and its Outcomes (PRESTO) trial.
OBJECTIVE
The aim of the present study was to determine the rates of target vessel revascularization (TVR) and to determine predictors of TVR from clinical and angiographic variables available in the Prevention of Restenosis With Tranilast and its Outcomes (PRESTO) database.


BACKGROUND
The rates of TVR after percutaneous revascularization procedures, and its prediction with available clinical and angiographic variables, is less well known.


METHODS
We studied nine-month TVR in 11,484 patients enrolled in the PRESTO trial. Clinical, lesion-related, and procedural characteristics were analyzed in a logistic regression model. Study data were divided at random into an 80% training set on which the models were developed and a 20% hold-out set on which the model properties were evaluated.


RESULTS
A total of 14% (n = 1,609) had ischemic TVR. Clinical variables with increased risk for TVR included younger age; hypertension; diabetes mellitus; nonsmokers; unstable angina; previous coronary artery bypass grafting; peripheral vascular disease; procedure- and lesion-related such as ostial location, multilesion angioplasty, location in the left anterior descending artery, length > or =20 mm, in-stent restenosis at baseline, and use of rotablator. There was significant increase in the risk of ischemic TVR at U.S. treatment sites. Smoking and stent placement were associated with lower risk of ischemic TVR. The mean area (+/- SD) under the receiver-operating characteristic curve of the bootstrap samples was 0.66, indicating a modest ability of the model to discriminate patients who needed TVR on follow-up.


CONCLUSIONS
Despite being the largest prospective trial designed to test restenosis, the discriminatory ability of the clinical and angiographic variables to predict TVR is modest.
Singh
Mandeep
M
Division of Internal Medicine and Cardiovascular Diseases, Mayo Clinic and Foundation, 200 Second Street SW, Rochester, MN 55905, USA.
Gersh
Bernard J
BJ
McClelland
Robyn L
RL
Ho
Kalon K L
KK
Willerson
James T
JT
Penny
William F
WF
Holmes
David R
DR
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D018849:Controlled Clinical Trials as Topic; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology*; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D012086:Reoperation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome