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CLINICAL RESEARCH

Drug-Eluting Stent Restenosis

The Pattern Predicts the Outcome

John Cosgrave, MRCP^_*, Gloria Melzi, MD^_*, Giuseppe G.L. Biondi-Zoccai, MD, Flavio Airoldi, MD, Alaide Chieffo, MD, Giuseppe M. Sangiorgi, MD^_*, Matteo Montorfano, MD, Iassen Michev, MD, Mauro Carlino, MD, Erminio Bonizzoni, PhD and Antonio Colombo, MD, FACC^_*,,_*

^_* EMO Centro Cuore Columbus, Milan, Italy
San Donato Hospital, Milan, Italy
San Raffaele Hospital, Milan, Italy
Institute of Medical Statistics and Biometry, University of Milan, Milan, Italy

Manuscript received August 10, 2005; revised manuscript received January 27, 2006, accepted February 21, 2006.

^_* Reprint requests and correspondence: Dr. Antonio Colombo, EMO Centro Cuore Columbus, 48 Via M. Buonarroti, 20145 Milan, Italy (Email: info{at}emocolumbus.it).

OBJECTIVES: We sought to determine if the angiographic pattern of in-stent restenosis in drug-eluting stents (DES) maintains its prognostic importance.

BACKGROUND: The pattern of restenosis in the bare-metal stent era had a significant impact on therapeutic outcomes.

METHODS: We identified a total of 250 consecutive restenotic lesions in 203 patients (66.4% sirolimus-eluting stents and 33.6% paclitaxel-eluting stents). We divided these lesions into two groups: focal, defined as 10 mm, 163 lesions (65.2%); and nonfocal, which were diffuse, proliferative, or obstructive, 87 lesions (34.8%). The end points analyzed were angiographic restenosis and target lesion revascularization (TLR).

RESULTS: Diabetes was the only clinical variable associated with the pattern of restenosis (28.8% focal compared with 52.9% diffuse; p = 0.0001). Angiographic follow-up of the treatment of restenosis was available in 61.2% of the lesions and was similar between the two groups. The rate of angiographic restenosis was 17.8% in the focal group and 51.1% in the nonfocal group (p = 0.0001). The incidence of TLR also increased with the type of restenosis treated (9.8% and 23%, respectively; p = 0.007). An adjusted multivariate analysis revealed that the pattern of restenosis remained associated with both the occurrence of restenosis and TLR (odds ratio [OR] 5.1 [95% confidence interval (CI) 1.1 to 23], p = 0.03; and OR 3.61 [95% CI 1.2 to 10.9], p = 0.02; respectively).

CONCLUSIONS: Similar to bare-metal stent data, the angiographic pattern of restenosis following DES implantation is prognostically important. Diabetes is a significant predictor of the pattern of restenosis in the DES era.

Abbreviations and Acronyms   BMS = bare-metal stents   DES = drug-eluting stents   IQR = interquartile range   ISR = in-stent restenosis   MACE = major adverse cardiac events   PES = paclitaxel-eluting stents   SES = sirolimus-eluting stents   TLR = target lesion revascularization   TVR = target vessel revascularization

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