Usefulness of predictors of angiographic restenosis to predict clinical restenosis after coronary stent placement

Introduction. After coronary stenting, several predictors of angiographic i n-stent restenosis have been identified in different studies, howewer, litt le is known about predictors of clinical restenosis, a more functional aspe ct of coronary restenosis. Objective. To assess whether risk factors for angiographic restenosis previ ously described, are able to predict clinical reestenosis and at what rate in current practice. Patients and methods. 216 consecutive patients (271 stents in 256 lesions) with procedural success were followed-up for 17.6 +/- 10 months during peri odic visits. Clinical restenosis was defined as the presence of symptoms or signs of myocardial ischemia, associated with greater than or equal to 50% diameter stenosis on the angiogram. Results. Clinical restenosis ocurred in 33 lesions (13%), which were revasc ularized with 34 stents associated with unstable angina in 29, acute myocar dial infarction in three and death in one case. Multivariate analysis ident ified as independent predictors of clinical restenosis, a vessel diameter l ess than 3 mm (p < 0.001, OR 4.5), a restenotic lesion (p = 0.01, OR 2.9) a nd the presence of residual stenosis by visual stimate (>0%) after implanta tion (p = 0.02, OR 2.5), These three risk factors explained most clinical r estenosis (73%), with rates of 22% when at least one was present and 4% in absence of all these. The presence of diabetes mellitus, the location in th e anterior descending coronary artery or at coronary ostium, and the number or total length of stents per lesion did not achieve an independent, signi ficant association as predictors of clinical restenosis. Conclusion. Most clinical restenosis after coronary stenting can be predict ed by the restenotic character of the revascularized lesion, the diameter o f the vessel being less than 3 mm and the presence of residual stenosis by visual stimate at the end of procedure.