Drug-eluting stent restenosis the pattern predicts the outcome.
OBJECTIVE
We sought to determine if the angiographic pattern of in-stent restenosis in drug-eluting stents (DES) maintains its prognostic importance.


BACKGROUND
The pattern of restenosis in the bare-metal stent era had a significant impact on therapeutic outcomes.


METHODS
We identified a total of 250 consecutive restenotic lesions in 203 patients (66.4% sirolimus-eluting stents and 33.6% paclitaxel-eluting stents). We divided these lesions into two groups: focal, defined as < or =10 mm, 163 lesions (65.2%); and nonfocal, which were diffuse, proliferative, or obstructive, 87 lesions (34.8%). The end points analyzed were angiographic restenosis and target lesion revascularization (TLR).


RESULTS
Diabetes was the only clinical variable associated with the pattern of restenosis (28.8% focal compared with 52.9% diffuse; p = 0.0001). Angiographic follow-up of the treatment of restenosis was available in 61.2% of the lesions and was similar between the two groups. The rate of angiographic restenosis was 17.8% in the focal group and 51.1% in the nonfocal group (p = 0.0001). The incidence of TLR also increased with the type of restenosis treated (9.8% and 23%, respectively; p = 0.007). An adjusted multivariate analysis revealed that the pattern of restenosis remained associated with both the occurrence of restenosis and TLR (odds ratio [OR] 5.1 [95% confidence interval (CI) 1.1 to 23], p = 0.03; and OR 3.61 [95% CI 1.2 to 10.9], p = 0.02; respectively).


CONCLUSIONS
Similar to bare-metal stent data, the angiographic pattern of restenosis following DES implantation is prognostically important. Diabetes is a significant predictor of the pattern of restenosis in the DES era.
Cosgrave
John
J
EMO Centro Cuore Columbus, Milan, Italy.
Melzi
Gloria
G
Biondi-Zoccai
Giuseppe G L
GG
Airoldi
Flavio
F
Chieffo
Alaide
A
Sangiorgi
Giuseppe M
GM
Montorfano
Matteo
M
Michev
Iassen
I
Carlino
Mauro
M
Bonizzoni
Erminio
E
Colombo
Antonio
A
D003131:Combined Modality Therapy; D023903:Coronary Restenosis / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000150:complications; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage*; D011379:Prognosis; D011446:Prospective Studies; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents
D017239:Paclitaxel; D020123:Sirolimus