Incidence and Predictors of Restenosis After Coronary Stenting in 10,004 Patients With Surveillance Angiography

Study Questions:

What are the incidence and predictors of restenosis in patients undergoing coronary stenting?

Methods:

The authors retrospectively reviewed the data of all patients undergoing successful implantation of coronary stents for de novo lesions from 1998 to 2009, and follow-up angiography at 6-8 months at two centers in Germany. Patients with cardiogenic shock, dialysis-dependent renal insufficiency, or previous cardiac transplantation were excluded. Angiographic restenosis was defined as diameter stenosis ≥50% in the in-segment area at follow-up angiography.

Results:

The study population was comprised of 12,094 patients. Angiographic follow-up was available for 10,004 patients (77.5%) with 15,004 treated lesions. Binary restenosis was detected in 2,643 (26.4%) patients and a progressive reduction in restenosis was seen with successive evolution in device design with 30% restenosis with bare-metal stents (BMS), 15% with first-generation drug-eluting stents (DES), and 12% with second-generation DES. Use of first-generation DES versus BMS (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.31-0.39) and second-generation DES versus first-generation DES (OR, 0.67; 95% CI, 0.58-0.77) were independent predictors of lower rates of restenosis. At multivariate analysis, smaller vessel size (OR, 1.59; 95% CI, 1.52-1.68, for each 0.5 mm decrease), total stented length (OR, 1.27; 95% CI, 1.21-1.33, for each 10 mm increase), complex lesion morphology (OR, 1.35; 95% CI, 1.21-1.51), presence of diabetes mellitus (OR, 1.32; 95% CI, 1.19-1.46), and history of bypass surgery (OR, 1.38; 95% CI, 1.20-1.58) were independently associated with restenosis.

Conclusions:

In this large cohort of patients with angiographic surveillance, there has been sequentially improved efficacy from BMS to first-generation DES to second-generation DES. Predictors of restenosis were small vessel size, increased stented length, complex lesion morphology, diabetes mellitus, and prior bypass surgery.

Perspective:

This study adds to the large body of data demonstrating the remarkable anti-restenotic efficacy of DES and the clinical efficacy of the second-generation DES. This reduction in angiographic restenosis has been associated with a reduction in target vessel revascularization, and has translated into better quality of life for patients with coronary artery disease.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Stable Ischemic Heart Disease, Chronic Angina

Keywords: Coronary Restenosis, Germany, Diabetes Mellitus, Stents


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