Interlesion Dependence of the Risk for Restenosis in Patients With Coronary Stent Placement in Multiple Lesions

Abstract

Background-Little is known about the behavior with regard to restenosis of multiple lesions within the same patient treated with intracoronary stenting. Our objective was to test the hypothesis that there is an intrapatient dependence of restenosis between lesions. Methods and Results-Quantitative analysis was carried out on angiograms obtained before, immediately after, and at 6 months after coronary stent placement in 1734 lesions in 1244 patients. We used a specialized logistic regression that not only accounts for intraclass correlation but also quantifies it in the form of odds ratio (OR) as the change in risk of a lesion to develop restenosis if another companion lesion had restenosis. The model was based on 23 patient-and lesion-related variables with binary restenosis (diameter stenosis Ն50%) as end point. The overall restenosis rate was 27.5%: 24.4% for single-lesion, 28.6% for double-lesion, and 33.8% for Ն3-lesion interventions. After adjustment for the influence of significant factors (hypercholesterolemia, systemic arterial hypertension, diabetes mellitus, previous PTCA, ostial lesion, location in left anterior descending coronary artery, number of stents placed, vessel size, stenosis severity, balloon-to-vessel ratio, and final result), the analysis found a significant intrapatient correlation, OR 2.5 (1.8 to 3.6). This means that in patients with multilesion interventions, the risk of a lesion to develop restenosis is 2.5 times higher if a companion lesion has restenosis, independently of the presence or absence of analyzed patient risk factors (eg, diabetes). Conclusions-This study demonstrates that there is a dependence of restenosis between coronary lesions in patients who undergo a multilesion intervention. The likelihood of restenosis for a lesion is higher when another companion lesion has also developed restenosis. Other, as yet unidentified patient factors may be the source of this intrapatient correlation of restenosis.

Predictive Factors for Restenosis after Drug-Eluting Stent Implantation

“…The distribution of late loss for the Cypher stent appeared largely skewed to the right with a Gaussian distribution. 29) In addition, we found that late loss was higher in the Taxus stent group than in the Cypher stent group, demonstrating that late lumen loss tended to favor the Cypher (Fig. 2).…”

Genetic Inflammatory Factors Predict Restenosis After Percutaneous Coronary Interventions

“…In patients with multivessel disease, the incidence of restenosis of a second lesion was 2.5 times higher if the first lesion had restenosis, even after adjustments for well-known patient-related risk factors, including diabetes and hypertension. 9 Inflammatory responsiveness is highly genetically determined. Many studies have demonstrated genetic influences on the inflammatory response of an individual.…”

p27 kip1 –838C>A Single Nucleotide Polymorphism Is Associated With Restenosis Risk After Coronary Stenting and Modulates p27 kip1 Promoter Activity

“…4,5 Several lines of evidence indicate that genetic factors may explain the excessive risk of restenosis independently of conventional clinical and procedural parameters. 6,7 Consequently, additional genetic tests to identify patients at increased risk of restenosis may lead to improved risk stratification and eventually individual, patient-tailored therapy. This concept has resulted in genetic studies designed to identify single nucleotide polymorphisms (SNPs) in genes associated with restenosis.…”