| Moo Hyun Kim³, Soon Jun Hong¹, Tae Hoon Ahn² , Eak-Kyun Shin² ,Mi Young Park¹ , Sung Hee Shin¹ , Youn Won Lee¹ , Wan Joo Shim¹ , Young Moo Ro¹ , Do-Sun Lim¹ |
Background: Although drug-eluting stents (DES) have reduced the rate of restenosis, patients with long diffuse lesions in addition to small vessels are at an increased risk for in-stent restenosis after DES implantation. We investigated the predictors of restenosis after DES implantation in long atherosclerotic lesions with small coronary arteries.
Methods and Results: Stented patients (n=221) with DESs were retrospectively reviewed for inclusion in the study from the PCI database. Patients with either sirolimus-eluting stent implantation (SES, n=157) or paclitaxel-eluting stent implantation (PES, n=64) with angiographic reference diameter (RD) of <2.75mm and lesion length of > 20 mm were included. At six months follow-up, 40 patients (23 patients [14.6%] with SES vs. 17 patients [26.6%] with PES, p=0.037) showed binary restenosis (restenosis of ≥ 50% diameter). Baseline clinical and angiographic characteristics were similar except for greater percent diameter stenosis before DES implantation (79.7 ± 13.9% vs. 68.0 ± 28.7%, p<0.001) and smaller minimal luminal diameter after DES implantation (2.33 ± 0.41 mm vs. 2.45 ± 0.26 mm, p=0.019) in the restenosis group. Univariate predictors of restenosis were the use of PES implantation (odds ratios [OR] 2.107, 95% confidence interval [CI] 1.037-4.284, p=0.039), longer lesion length (OR 1.053, 95% CI 1.010-1.098, p=0.016), smaller post-PCI minimum lumen diameter (OR 0.270, 95% CI 0.085-0.856, p=0.026), smaller pre-PCI RD (OR 0.394, 95% CI 0.202-0.770, p=0.006), and greater pre-PCI percent diameter stenosis (OR 1.025, 95% CI 1.004-1.046, p=0.020). By multivariate logistic regression analysis, only greater pre-PCI percent diameter stenosis (OR 1.051, 95% CI 1.023-1.081, p<0.001), smaller pre-PCI RD (OR 0.249, 95% CI 0.063-0.987, p=0.048), the use of PES (OR 3.607, 95% CI 1.427-9.121, p=0.007), and longer lesion length (OR 1.072, 95% CI 1.015-1.133, p=0.013) were associated with restenosis.
Conclusion: Greater percent diameter stenosis with small vessel size before DES implantation and the use of PES with longer lesion length are significant predictors of restenosis in long atherosclerotic lesions with small coronary arteries.
|
