Clinical and quantitative coronary angiographic predictors of coronary restenosis - A comparative analysis from the balloon-to-stent era

OBJECTIVES We sought to assess whether coronary stents have modified the pr edictive value of demographic, clinical and quantitative coronary angiograp hic (QCA) predictors of coronary restenosis. BACKGROUND A systematic analysis in a large cohort of registries and random ized trials of the percutaneous transluminal coronary angioplasty (PTCA) an d stent era has never been performed. METHODS A total of 9,120 treated lesions in 8,156 patients included in nine randomized trials and 10 registries, with baseline, post-procedural and si x-month follow-up QCA analyses, were included in this study. Predictors of restenosis were identified with univariate and multivariate logistic regres sion analyses. Interaction terms were introduced in the regression equation to evaluate whether the predictors of restenosis were common to both eras or specific for either one of the revascularization techniques. RESULTS The restenosis rate was 35% after PTCA and 19% after angioplasty wi th additional stenting. In the univariate analysis, favorable predictors we re previous coronary artery bypass graft surgery (CABG), stent use, stent l ength and a large pre-procedural minimal lumen diameter (pre-MLD); unfavora ble predictors were weight, body mass index, diabetes mellitus, multi-vesse l disease, lesion length and a high residual post-procedural diameter steno sis (post-DS). Predictors specific for the PTCA population were a large pos t-procedural MLD (post-MLD) as favorable and a severe pre-procedural DS (pr e-DS) as unfavorable. Favorable predictors specific for the stent populatio n were a large post-MLD and a large pre-procedural reference diameter (pre- RD). In the multivariate analysis, the best model included the following fa vorable predictors: stent use, a large post-MLD, previous CABG and the inte raction term between stent use and a large post-MLD; unfavorable predictors were lesion length and diabetes mellitus. CONCLUSIONS There are no major differences in demographic and clinical pred ictors of coronary restenosis between PTCA and stent populations. In the mo dern (stent) era, a severe pre-DS is no longer an unfavorable predictor of restenosis. Still important, but more so in the stent population, is a larg e post-MLD (optimal result). Finally, a larger pre-RD became a favorable pr edictor with the advent of stenting. (C) 2001 by the American College of Ca rdiology.