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CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY

Predictors of diffuse and aggressive intra-stent restenosis

Steven L. Goldberg, MD, FACC^*, Arthur Loussararian, MD, FACC^*, Joseph De Gregorio, MD, FACC, Carlo Di Mario, MD, Remo Albiero, MD and Antonio Colombo, MD, FACC

^* Harbor-UCLA Medical Center, Torrance, California, USA
Centro Cuore Columbus, Milan, Italy

Manuscript received November 5, 1999; revised manuscript received November 10, 2000, accepted December 13, 2000.

Reprint requests and correspondence: Dr. Steven L. Goldberg, Division of Cardiology, University of Washington School of Medicine, Box 356115, 1959 NE Pacific Street, Seattle, Washington 98195-6115
stevgold{at}u.washington.edu

OBJECTIVES

This study was performed to investigate the causes of diffuse and aggressive intra-stent restenosis.

BACKGROUND

Although restenosis is usually considered to be a dichotomous variable, there is clinical relevance to the severity of restenosis. It is not known which variables are predictive of diffuse or aggressive intra-stent restenosis.

METHODS

A consecutive series of 456 coronary lesions with in-stent restenosis was evaluated for the type of restenosis using quantitative coronary angiography. Restenosis was defined as 50% diameter stenosis at follow-up angiography, diffuse restenosis as a follow-up lesion length 10 mm and aggressive restenosis as either an increase in lesion length from the original lesion or a restenotic narrowing tighter than the original. Clinical, anatomic and procedural characteristics were evaluated for lesions associated with these types of restenosis.

RESULTS

Diffuse restenosis was associated with a smaller reference artery diameter, longer lesion length, female gender, longer stent length and the use of coil stents. Aggressive restenosis was more common in women, with the use of Wallstents and with long stent to lesion length ratios. Aggressive restenosis occurred earlier and was more closely associated with symptoms and myocardial infarctions than nonaggressive restenotic lesions.

CONCLUSIONS

Markers for diffuse restenosis were also important markers for the presence of any restenosis. A long stent to lesion length ratio is an important marker for aggressive restenosis. When severe forms of in-stent restenosis occur, they tend to present earlier and with more symptoms, including myocardial infarction. More careful consideration of the type of in-stent restenosis may aid in identifying when alternative strategies may be useful.

Abbreviations and Acronyms   CI = confidence interval   MI = myocardial infarction   MLD = minimum lumen diameter   OR = odds ratio

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