Incidence and Predictors of Restenosis After Coronary Stenting in 10,004 Patients With Surveillance Angiography
What are the incidence and predictors of restenosis in patients undergoing coronary stenting?
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.
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.
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.
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.
Keywords: Coronary Restenosis, Germany, Diabetes Mellitus, Stents
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