Usefulness of quantitative and qualitative angiographic lesion morphology, and clinical characteristics in predicting major adverse cardiac events during and after native coronary balloon angioplasty

Hermans, Walter R.M.; Foley, David P.; Rensing, Benno J.; Rutsch, Wolfgang; Heyndrickx, Guy R.; Danchin, Nicolás; Mast, Gijs; Hanet, Claude; Lablanche, Jean‐Marc; Rafflenbeul, W.; Uebis, R.; Balcon, Raphael; Feyter, Pim J. de; Serruys, Patrick W.

doi:10.1016/0002-9149(93)90211-t

Cited by 102 publications

(62 citation statements)

References 27 publications

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“…Although most of the studies on prediction of restenosis antedate the use of stents, there has been no change in the clinical variables predicting restenosis. 3,5,7,11 Diabetes mellitus continues to be a strong clinical predictor of restenosis. 4,12 In the present study, patients with treated diabetes mellitus had a 45% higher risk of restenosis compared with nondiabetics.…”

Section: Clinical and Angiographic Predictors Of Restenosismentioning

confidence: 99%

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Clinical and Angiographic Predictors of Restenosis After Percutaneous Coronary Intervention

et al. 2004

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Background-Restenosis prediction from published studies is hampered by inadequate sample size and incomplete angiographic follow-up. The prediction of restenosis with the existing variables is poor. The aim of the present study was to include the clinical and angiographic variables commonly associated with angiographic restenosis and develop a prediction model for restenosis from the PRESTO database. Methods and Results-This study included 1312 patients with a single lesion enrolled in the angiographic substudy of the PRESTO trial. We constructed 2 risk scores. The first used preprocedural variables (female gender, vessel size [Յ2.5 mm, 2.5 to 3 mm, 3 to 3.5 mm, 3.5 to 4 mm, Ͼ4 mm], lesion length Ͼ20 mm, diabetes, smoking status, type C lesion, any previous percutaneous coronary intervention [PCI], and unstable angina) derived from previous studies. Estimated restenosis rates and corresponding variability for each possible level of the resultant risk score were obtained via bootstrapping techniques. The area under the receiver-operator characteristic (ROC) curve was 0.63, indicating modest discriminatory ability to predict restenosis. The second approach constructed a multiple logistic regression model considering significant univariate clinical and angiographic predictors of restenosis identified from the PRESTO database (treated diabetes mellitus, nonsmoker, vessel size, lesion length, American College of Cardiology/American Heart Association type C lesion, ostial location, and previous PCI). The area under the ROC curve for this risk score was also 0.63. Conclusions-The preprocedural clinical and angiographic variables from available studies and from the PRESTO trial have only modest predictive ability for restenosis after PCI.

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Section: Clinical and Angiographic Predictors Of Restenosismentioning

confidence: 99%

“…Many clinical, angiographic, and procedural variables have been studied as predictors for restenosis. [1][2][3][4][5][6][7] Most of these studies from which the variables were derived had smaller sample size, retrospective analyses, and different definitions of restenosis. The predictive accuracy of most of the available studies is relatively poor.…”

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confidence: 99%

Clinical and Angiographic Predictors of Restenosis After Percutaneous Coronary Intervention

et al. 2004

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“…18 Myocardial infarction was defined as development of new pathological Q waves and/or an increase of more than twice the upper limit of normal of levels of creatine kinase, with concomitant elevation of the MB fraction. Compliance with trial medication was defined as consumption of Ͼ80% of trial medication in the first month and Ͼ75% of medication thereafter.…”

Section: Definitionsmentioning

confidence: 99%

Carvedilol for Prevention of Restenosis After Directional Coronary Atherectomy

et al. 2000

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on behalf of the EUROCARE study groupBackground-In addition to its known properties as a competitive, nonselective ␤ and ␣-1 receptor blocker, carvedilol directly inhibits vascular myocyte migration and proliferation and exerts antioxidant effects that are considerably greater than those of vitamin E or probucol. This provides the basis for an evaluation of carvedilol for the prevention of coronary restenosis. Methods and Results-In a prospective, double-blind, randomized, placebo-controlled trial, 25 mg of carvedilol was given twice daily, starting 24 hours before scheduled directional coronary atherectomy and continuing for 5 months after a successful procedure. The primary end point was the minimal luminal diameter as determined during follow-up angiography 26Ϯ2 weeks after the procedure. Of 406 randomized patients, 377 underwent attempted atherectomy, and in 324 (88.9%), a Յ50% diameter stenosis was achieved without the use of a stent. Evaluable follow-up angiography was available in 292 eligible patients (90%). No differences in minimal luminal diameter (1.99Ϯ0.73 mm versus 2.00Ϯ0.74 mm), angiographic restenosis rate (23.4% versus 23.9%), target lesion revascularization (16.2 versus 14.5), or event-free survival (79.2% versus 79.7%) between the placebo and carvedilol groups were observed at 7 months. Conclusions-The maximum recommended daily dose of the antioxidant and ␤-blocker carvedilol failed to reduce restenosis after successful atherectomy. These findings are in contrast to those of the Multivitamins and Probucol Trial, which raises doubts regarding the validity of the interpretation that restenosis reduction by probucol was via antioxidant effects. The relationship between antioxidant agents and restenosis remains to be elucidated. (Circulation.

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“…Despite considerable progress, restenosis remains a major limitation of PCI. Many clinical, angiographic, and procedural variables have been studied as predictors for restenosis (1)(2)(3)(4)(5)(6)(7). The prediction of restenosis with the existing variables is poor.…”

Section: Introductionmentioning

confidence: 99%

An important role for VCAM-1, but not for ICAM-1 in restenosis following coronary stent implantation

Bayata¹,

Arıkan²,

Yeşìl³

et al. 2010

Anadolu Kardiyol Derg

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Amaç: Bu çalışmada stabil koroner arter hastalığı nedeni ile stent implante edilen olgularda, adezyon moleküllerinin seviyesi ile restenoz arasındaki ilişki araştırılmıştır. Yöntemler: Stabil angina pectoris nedeni ile proksimal sol ön inen artere stent implante edilen 15 olguda işlem öncesi ve sonrasında dolaşım-daki hücreler arası adezyon molekül-1 (ICAM-1) ve vasküler hücre adezyon molekül -1 (VCAM-1) seviyeleri prospektif gözlemsel olarak araştı-rılmıştır. Hastalarda çıplak metal stent kullanılmıştır. Tüm hastalara restenoz değerlendirmesi amacı ile tespiti için implantasyonun 6. ayında tekrar koroner anjiyografi yapıldı. Çalışma sonunda restenoz saptanan ve saptanmayan hastalara ait sürekli değişkenler Mann-Whitney U testi ile karşılaştırıldı. Tekrarlanan ölçümlere ait sürekli değişkenlerin karşılaştırılmasında Wilcoxon T testi kullanıldı. Kategorik veriler ise Ki-kare testi ile karşılaştırıldı. Bulgular: Perkütan koroner girişim (PKG) öncesi bazal ICAM-1 ve VCAM-1 konsantrasyonları sırası ile 4.89±2.28 ve 46.35±22.96 ng/ml bulunmuş-tur. Ölçülen ICAM-1 ve VCAM-1 seviyeleri PKG' den 24 saat sonra istatistik olarak anlamsız derecede artış göstermiştir (5.01±2.35ng/ml ve 52.57±19.40 ng/ml). Altı olguda (%40) 6. ayda restenoz tespit edilmiştir. Restenoz gelişen ve gelişmeyen hasta grupları arasında ortalama stent uzunluğu, çapı ve balon şişme basıncı bakımından fark bulunmamıştır. Stent implantasyonundan önce ve sonra ölçülen VCAM değerleri restenoz olmayan grupta anlamlı değişiklik göstermemiş, bununla birlikte restenoz grubunda anlamlı artış göstermiştir (45.1±21.0' den 57.2±14.3 ng/ml'ye, p<0.05). Bazal ve post PKG ICAM-1 değerleri restenoz olan ve olmayan gruplarda anlamlı değişiklik göstermemiştir. Sonuç: Bu sonuçlar koroner stent implantasyonunu takip eden restenozda adezyon moleküllerinden ICAM-1'e göre VCAM-1'in daha önemli rolü olduğunu düşündürmektedir. (Anadolu Kardiyol Derg 2010; 10: 405-9) Anahtar kelimeler: Restenoz, stent, inflamasyon, vasküler hücre adezyon molekül -1, hücreler arası adezyon molekül-1 ÖZET Objective: In this study, we evaluated the possibility that, levels of circulating adhesion molecules following direct stent implantation may be a marker of restenosis. Methods: This prospective, observational study investigated levels of circulating intercellular (ICAM-1), and vascular cell (VCAM-1) adhesion molecules in 15 patients with stable angina pectoris before and after coronary stent implantation for single vessel-single lesion disease in proximal left anterior descending artery. All patients received bare-metal stents. Patients underwent repeat coronary angiography for detection of restenosis at 6 month. Continuous data between patients with and without restenosis were compared using Mann-Whitney U test. Repeated measurements were compared using Wilcoxon T test. Categorical data were compared using Chi-square statistics. Results: Baseline ICAM-1 and VCAM-1 concentrations before percutaneous coronary intervention (PCI) were 4.89±2.28 and 46.35±22.96 ng/ml respectively. Levels of ICAM ...

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Usefulness of quantitative and qualitative angiographic lesion morphology, and clinical characteristics in predicting major adverse cardiac events during and after native coronary balloon angioplasty

Cited by 102 publications

References 27 publications

Clinical and Angiographic Predictors of Restenosis After Percutaneous Coronary Intervention

Clinical and Angiographic Predictors of Restenosis After Percutaneous Coronary Intervention

Carvedilol for Prevention of Restenosis After Directional Coronary Atherectomy

An important role for VCAM-1, but not for ICAM-1 in restenosis following coronary stent implantation

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