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Clinical restenosis after coronary stenting: perspectives from multicenter clinical trials

Donald E. Cutlip, MD, FACC^*,*, Manish S. Chauhan, MD^*, Donald S. Baim, MD, FACC^*, Kalon K. L. Ho, MD, MSc, FACC^*, Jeffrey J. Popma, MD, FACC, Joseph P. Carrozza, MD, FACC, David J. Cohen, MD, MSc, FACC^* and Richard E. Kuntz, MD, MSc, FACC^*

^* Harvard Clinical Research Institute, Boston, Massachusetts, USA
Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
Brigham and Women’s Hospital, Boston, Massachusetts, USA

View larger version (30K): [in a new window]   Figure 1 Clinical restenosis rates as exemplified by target lesion revascularization (TLR), target vessel revascularization (TVR), or target vessel failure (TVF) assessed at 6, 9, or 12 months. All events adjudicated by the Clinical Events Committee, and percentages determined by Kaplan-Meier method. Solid bar = TLR; striped bar = TVR; open bar = TVF.

View larger version (17K): [in a new window]   Figure 2 Cumulative distribution frequency of follow-up percent diameter stenosis for all patients undergoing target lesion revascularization (TLR). Adjudicated TLR indicates the Clinical Events Committee determined the TLR was clinically driven.

View larger version (18K): [in a new window]   Figure 3 (A) Cumulative distribution frequency of follow-up percent diameter stenosis for all patients with angiographic restenosis defined as the binary end point (50% diameter stenosis). (B) Target lesion revascularization (TLR) rates according to severity of angiographic restenosis. Adjudicated TLR indicates the Clinical Events Committee determined the TLR was clinically driven.

View larger version (12K): [in a new window]   Figure 4 Receiver operator characteristic curves for target lesion revascularization (TLR) as a function of severity of angiographic restenosis (A = any reported TLR; B = adjudicated TLR). An area under the curve approaching 1.0 represents optimal discrimination for the measure of interest (follow-up diameter stenosis [DS]). A result in the upper left hand corner of the graph would indicate a perfect cutoff value with maximum sensitivity and specificity. As shown in A and B, the cutoff value of 50% DS best represents this position.