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CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY

Clinical and quantitative coronary angiographic predictors of coronary restenosis

A comparative analysis from the balloon-to-stent era

Nestor Mercado, MD, DSc^*,1, Eric Boersma, PhD^*, William Wijns, MD, PhD, Bernard J. Gersh, MB, DPhil, ChB, FACC, Carlos A. Morillo, MD, Vincent de Valk, PhD^||, Gerrit-Anne van Es, PhD^||, Diederick E. Grobbee, MD, PhD^¶ and Patrick W. Serruys, MD, PhD, FACC^*

^* Thoraxcenter, University Hospital Dijkzigt, Rotterdam, The Netherlands
Cardiovascular Center, Onze Lieve Vrouw Ziekenhuis, Aalst, Belgium
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
Department of Cardiology, Fundacion Cardiovascular del Oriente Colombiano, Bucaramanga, Colombia
^¶ Julius Center for Patient Oriented Research, University Medical Center, Utrecht, The Netherlands
^|| Cardialysis, Rotterdam, The Netherlands

Manuscript received December 7, 2000; revised manuscript received May 7, 2001, accepted May 21, 2001.

Reprint requests and correspondence: Dr. Eric Boersma, Thoraxcenter, University Hospital Rotterdam, Room H-543, Dr Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
boersma{at}thch.azr.nl

OBJECTIVES

We sought to assess whether coronary stents have modified the predictive value of demographic, clinical and quantitative coronary angiographic (QCA) predictors of coronary restenosis.

BACKGROUND

A systematic analysis in a large cohort of registries and randomized trials of the percutaneous transluminal coronary angioplasty (PTCA) and stent era has never been performed.

METHODS

A total of 9,120 treated lesions in 8,156 patients included in nine randomized trials and 10 registries, with baseline, post-procedural and six-month follow-up QCA analyses, were included in this study. Predictors of restenosis were identified with univariate and multivariate logistic regression analyses. Interaction terms were introduced in the regression equation to evaluate whether the predictors of restenosis were common to both eras or specific for either one of the revascularization techniques.

RESULTS

The restenosis rate was 35% after PTCA and 19% after angioplasty with additional stenting. In the univariate analysis, favorable predictors were previous coronary artery bypass graft surgery (CABG), stent use, stent length and a large pre-procedural minimal lumen diameter (pre-MLD); unfavorable predictors were weight, body mass index, diabetes mellitus, multi-vessel disease, lesion length and a high residual post-procedural diameter stenosis (post-DS). Predictors specific for the PTCA population were a large post-procedural MLD (post-MLD) as favorable and a severe pre-procedural DS (pre-DS) as unfavorable. Favorable predictors specific for the stent population were a large post-MLD and a large pre-procedural reference diameter (pre-RD). In the multivariate analysis, the best model included the following favorable predictors: stent use, a large post-MLD, previous CABG and the interaction term between stent use and a large post-MLD; unfavorable predictors were lesion length and diabetes mellitus.

CONCLUSIONS

There are no major differences in demographic and clinical predictors of coronary restenosis between PTCA and stent populations. In the modern (stent) era, a severe pre-DS is no longer an unfavorable predictor of restenosis. Still important, but more so in the stent population, is a large post-MLD (optimal result). Finally, a larger pre-RD became a favorable predictor with the advent of stenting.

Abbreviations and Acronyms   CABG = coronary artery bypass graft surgery   CI = confidence interval   DS = diameter stenosis   IVUS = intravascular ultrasound   LAD = left anterior descending coronary artery   MLD = minimal lumen diameter   PTCA = percutaneous transluminal coronary angioplasty   OR = odds ratio   QCA = quantitative coronary angiography   RD = reference diameter

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