Document Detail


Correlates of clinical restenosis following intracoronary implantation of drug-eluting stents.
MedLine Citation:
PMID:  17826379     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Despite significant decreases in restenosis and repeated intervention achieved using drug-eluting stents (DESs), the benefit has not been homogenous across all patient and lesion subsets. Identification of correlates of DES restenosis may allow a differing management approach and lead to improved patient outcomes. The study population consisted of 3,535 consecutive patients (5,046 lesions) who underwent successful sirolimus- or paclitaxel-eluting stent implantation for >or=1 native coronary artery or bypass graft lesion from April 2003 to September 2006. From this cohort, 197 patients (237 lesions) were identified to have in-stent restenosis (ISR) requiring revascularization within 12 months of stent implantation. This group was compared with the remainder of the patient population. Logistic regression analysis was performed to identify independent predictors of DES ISR. Independent correlates of DES ISR using multivariate analysis included both clinical and procedural factors. Clinical predictors were age, hypertension, and unstable angina. Procedural predictors were left anterior descending artery intervention, number of stents implanted, stented length/lesion, and lack of intravascular ultrasound guidance. Implantation of >or=3 stents was associated with a significantly higher restenosis risk (9.7% vs 5.1%; p=0.0003). A 10-mm increase in stented length was associated with an adjusted odds ratio of 1.18 (95% confidence interval 1.03 to 1.35). Diabetes, stent diameter, and stent type were found not to be predictive of DES ISR. In conclusion, correlates of DES ISR included both clinical and procedural factors. Limiting the number of stents and stented length, in addition to intravascular ultrasound guidance, may minimize DES ISR.
Authors:
Probal Roy; Teruo Okabe; Tina L Pinto Slottow; Daniel H Steinberg; Kimberly Smith; Rebecca Torguson; Zhenyi Xue; Natalie Gevorkian; Lowell F Satler; Kenneth M Kent; William O Suddath; Augusto D Pichard; Ron Waksman
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Publication Detail:
Type:  Journal Article     Date:  2007-07-02
Journal Detail:
Title:  The American journal of cardiology     Volume:  100     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2007 Sep 
Date Detail:
Created Date:  2007-09-10     Completed Date:  2007-11-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  965-9     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, Washington Hospital Center, Washington, DC, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Transluminal, Percutaneous Coronary*
Coronary Restenosis / epidemiology*,  prevention & control,  ultrasonography
Coronary Vessels / ultrasonography
Female
Humans
Immunosuppressive Agents / administration & dosage
Logistic Models
Male
Middle Aged
Multivariate Analysis
Paclitaxel / administration & dosage
Retreatment
Sirolimus / administration & dosage
Stents*
Ultrasonography, Interventional
Chemical
Reg. No./Substance:
0/Immunosuppressive Agents; 33069-62-4/Paclitaxel; 53123-88-9/Sirolimus

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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