Restenosis after coronary placement of various stent types

Coronary stent implantation is being performed in an increasing number of p atients with a wide spectrum of clinical and lesion characteristics. A vari ety of stent designs are now available and continuous efforts ore being mad e to improve the stent placement procedure. The objective of this study was to perform a comprehensive analysis of the relation between clinical, lesi on, and procedural factors, and restenosis after intracoronary stenting in a large and unselected population of patients. A consecutive series of 4,51 0 patients with coronary stent placement was analyzed. Exclusion criteria w ere only a failed procedure and an adverse outcome within the first month a fter the intervention. Follow-up angiography was performed in 80% of patien ts at 6 months. Clinical, lesion, and procedural data from all 3,370 patien ts (4,229 stented lesions) with follow-up angiography were analyzed in a lo gistic regression model for restenosis (greater than or equal to 50% diamet er stenosis). Clinical factors contributed to the predictive power of the m odel much less than lesion and procedural factors. The strongest risk facto r for restenosis was a small vessel size, with a 79% increase in the risk f or a vessel of 2.7 mm versus a vessel of 3.4 mm in diameter. Stent design w as the second strongest factor; the incidence of restenosis ranged from 20. 0% to 50.3% depending on the stent type implanted. In conclusion, this stud y demonstrates the predominant role of lesion and procedural factors in det ermining the occurrence of restenosis after coronary stent placement. Among these factors, stent design appears to play a particularly important role in the hyperplastic response of the vessel wall. (C) 2001 by Excerpta Medic a, Inc.