Factors predictive of cardiac events and restenosis after sirolimus-eluting stent implantation in small coronary arteries.
OBJECTIVE
Predictors of cardiac events and restenosis after sirolimus-eluting stent (SES) implantation in small coronary arteries were evaluated.


BACKGROUND
Although SES implantation has markedly reduced the risk of restenosis, small vessel disease remains a major cause of SES failure.


METHODS
We prospectively investigated the factors predictive of cardiac events and restenosis in 1,092 consecutive patients who received SES implantation for 1,269 lesions in small coronary arteries (< or = 2.8 mm). Follow-up angiography at 6 months was performed in 751 patients with 889 lesions (follow-up rate 70.3%).


RESULTS
Restenosis (diameter stenosis > or = 50%) was angiographically documented in 65 patients with 77 lesions (8.7%): 55 focal (71.4%), 8 diffuse (10.4%), 2 diffuse proliferative (2.6%), and 12 total (15.6%). Lesion length, stent length, reference artery size, and in-stent restenotic lesions were univariate predictors of restenosis. By multivariate analysis, lesion length (OR 1.04; 95% CI 1.02-1.05; P < 0.001) and in-stent restenotic lesions (OR 3.38; 95% CI 1.80-6.35; P < 0.001) were significant independent predictors of restenosis. During follow-up (23.2 +/- 7.9 months), there were 17 deaths (5 cardiac and 12 noncardiac), 5 nonfatal Q-wave myocardial infarctions, and 42 target lesion revascularizations. The cumulative probability of survival without major adverse cardiac events (MACE) was (96.6 +/- 0.6)% at 1 year and (95.1 +/- 0.7)% at 2 years. In multivariate analysis, lesion length (HR 1.04; 95% CI 1.01-1.07; P = 0.004) and in-stent restenotic lesions (HR 3.29; 95% CI 1.58-6.86; P = 0.001) were independently related to MACE.


CONCLUSIONS
SES implantation in small coronary arteries is safe and effective, with lesion length having a major impact on restenosis and MACE.
Lee
Cheol Whan
CW
Department of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea.
Suh
Jon
J
Lee
Se-Whan
SW
Park
Duk-Woo
DW
Lee
Seung-Hwan
SH
Kim
Young-Hak
YH
Hong
Myeong-Ki
MK
Kim
Jae-Joong
JJ
Park
Seong-Wook
SW
Park
Seung-Jung
SJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D002317:Cardiovascular Agents / Q000008:administration & dosage / Q000009:adverse effects*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D023903:Coronary Restenosis / Q000175:diagnosis / Q000209:etiology; D023921:Coronary Stenosis / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage / Q000009:adverse effects*; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome
D002317:Cardiovascular Agents; D020123:Sirolimus