RESTENOSIS AFTER CORONARY STENTING IN CURRENT CLINICAL-PRACTICE

Background Randomized trials have demonstrated that planned coronary s tenting may lower restenosis rate in patients with de novo short lesio ns. In a prospective study we sought to determine the frequency of res tenosis, reocclusion, and adverse cardiovascular events after coronary stenting in a series of 258 consecutive nonselected patients, includi ng those with complex lesions not fulfilling past and ongoing randomiz ed trial criteria for stent implantation, Methods Criteria for stentin g were as follows: (1) dissection associated with occlusion or threate ned closure, (2) a residual percentage stenosis >30% or nonocclusive d issection, (3) restenotic lesion or chronic total occlusion. Results I n most cases (89%) the target lesion had two or more unfavorable morph ologic characteristics, whereas only 11% of target lesions could be cl assified as type A or B1 lesions. Overall, the 6-month restenosis rate was 23%. By use of subgroup analysis restenosis rate was found to ran ge widely, from 11% to 46%. With multivariate analysis, only four vari ables were found to be independently related to restenosis: age >63 ye ars (odds ratio [OR] = 2.651, p = 0.011), female sex (OR = 3.807, p = 0.002), lesion length >12 mm (OR 3.185, p = 0.002), and type C lesion (OR 2.527, p = 0.014). Conclusions Results from randomized trials on c oronary stenting cannot be extrapolated to current clinical practice b ecause most of the treated lesions do not fulfill the criteria adopted in these studies For stent implantation. The restenosis rate is nearl y four times greeter for long and complex lesions treated by multiple stent implantation as compared with simple lesions, and additional stu dies need to be performed to evaluate the efficacy of stenting on thes e lesions.