title: Drug-eluting stent restenosis the pattern predicts the outcome.
abstract: 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.
authors.affiliation: EMO Centro Cuore Columbus, Milan, Italy.
authors.forename: John
authors.initials: J
authors.lastname: Cosgrave
authors.forename: Gloria
authors.initials: G
authors.lastname: Melzi
authors.forename: Giuseppe G L
authors.initials: GG
authors.lastname: Biondi-Zoccai
authors.forename: Flavio
authors.initials: F
authors.lastname: Airoldi
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: Giuseppe M
authors.initials: GM
authors.lastname: Sangiorgi
authors.forename: Matteo
authors.initials: M
authors.lastname: Montorfano
authors.forename: Iassen
authors.initials: I
authors.lastname: Michev
authors.forename: Mauro
authors.initials: M
authors.lastname: Carlino
authors.forename: Erminio
authors.initials: E
authors.lastname: Bonizzoni
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: 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
chemical_list: D017239:Paclitaxel; D020123:Sirolimus