CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY
Geographical Differences in the Rates of Angiographic Restenosis and Ischemia-Driven Target Vessel Revascularization After Percutaneous Coronary Interventions
Results From the Prevention of Restenosis With Tranilast and its Outcomes (PRESTO) Trial
Mandeep Singh, MD*,
Brent A. Williams, MS ,
Bernard J. Gersh, MB, ChB, DPhil*,
Robyn L. McClelland, PhD,
Kalon K.L. Ho, MD, MSc ,
James T. Willerson, MD ,
William F. Penny, MD||,
Donald E. Cutlip, MD and
David R. Holmes, Jr, MD*,*
* Division of Internal Medicine and Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
Division of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
Harvard Clinical Research Institute, Boston, Massachusetts
Texas Heart Institute, Houston, Texas
|| University of California/VA Medical Center, San Diego, California
Manuscript received November 29, 2004;
revised manuscript received May 27, 2005,
accepted July 11, 2005.
* Reprint requests and correspondence: Dr. David R. Holmes, Jr., Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 2nd Street SW, Rochester, Minnesota 55905. (Email: holmes.david{at}mayo.edu).
OBJECTIVES: This study assessed the geographical differences in target vessel revascularization (TVR) after percutaneous coronary intervention (PCI) in the Prevention of Restenosis With Tranilast and its Outcomes (PRESTO) trial.
BACKGROUND: An aggressive approach to PCI is more common in the U.S. than in other countries. The impact of this approach on restenosis outcomes has not been studied.
METHODS: Using the PRESTO trial, we compared nine-month ischemic TVR after PCI in U.S.-treated patients (n = 5,026) with rates in other countries (n = 6,458). We defined TVR as repeat intervention for chest pain/positive stress test. Additionally, angiographic restenosis ( 50% narrowing or 50% loss of gain at nine-month follow-up) was compared between U.S. and non-U.S. patients within the prespecified angiographic subset (n = 2,823). Regression models were developed to adjust for clinical and lesion-related characteristics.
RESULTS: Higher rates of TVR (18% vs. 11%), and angiographic restenosis (65% vs. 48%) were observed in patients treated in the U.S. as compared with the other patients (p < 0.01 for both comparisons). Patients treated in the U.S. were more likely to be female, diabetic, not currently smoking, to have unstable angina, and to have a prior PCI. In U.S. patients, lesions tended to be longer, but less likely to be American College of Cardiology/American Heart Association class C. After adjusting for clinical and angiographic variables, PCI in the U.S. was still associated with increased angiographic restenosis and ischemic TVR.
CONCLUSIONS: Angiographic restenosis and ischemia-driven TVR rates were higher in patients treated in the U.S. The difference could only partially be explained by the higher prevalence of measured adverse clinical and angiographic features.
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Abbreviations and Acronyms
| | ACC/AHA = American College of Cardiology/American Heart Association | | MI = myocardial infarction | | PCI = percutaneous coronary intervention | | TVF = target vessel failure | | TVR = target vessel revascularization |
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