title: Angiographic patterns of in-stent restenosis in men and women.
abstract: BACKGROUND
  The angiographic classification of in-stent restenosis (ISR) has been described. However, no comparative analysis of the morphologic ISR patterns between sexes has been performed. We sought to assess the ISR rate and the morphology of the different ISR patterns in the two genders.
  
  
  METHODS
  The study population comprised 487 patients (231 male, 256 female) who underwent systematic angiographic follow-up 6 months after coronary stent implantation.
  
  
  RESULTS
  The angiographic patterns of ISR were defined as: a) focal (length < or = 10 mm), b) diffuse (length > 10 mm and within the stent margins), c) proliferative (length > 10 mm extending beyond the stent margins), and d) totally occlusive. Angiographic ISR had a significantly higher incidence in women as compared to men (35.9 vs 29.4%, p = 0.04). In addition, angiographic analysis showed that, although all ISR patterns were present in both sexes, more males had focal ISR (59.7 vs 28.2%, p < 0.001). Conversely, females showed a higher incidence of diffuse ISR (71.8 vs 40.3%, p < 0.001), including intrastent, proliferative and occlusive patterns. The only predictors of a specific ISR pattern were diabetes mellitus and hypertension for diffuse ISR in both sexes.
  
  
  CONCLUSIONS
  Females seem to be at higher risk of angiographic restenosis and higher levels of ISR class after coronary stent implantation. These findings may be prognostically important and should be considered for the appropriate use of newer revascularization strategies.
authors.affiliation: Institute of Cardiology, University of Milan, Centro Cardiologico "Monzino", IRCCS, Milan, Italy. daniela.trabattoni@cardiologicomonzino.it
authors.forename: Daniela
authors.initials: D
authors.lastname: Trabattoni
authors.forename: Franco
authors.initials: F
authors.lastname: Fabbiocchi
authors.forename: Piero
authors.initials: P
authors.lastname: Montorsi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Calligaris
authors.forename: Stefano
authors.initials: S
authors.lastname: Galli
authors.forename: Paolo
authors.initials: P
authors.lastname: Ravagnani
authors.forename: Stefano
authors.initials: S
authors.lastname: De Martini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Teruzzi
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Bartorelli
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003251:Constriction, Pathologic; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D015607:Stents