Clinical and quantitative coronary angiographic predictors of coronary restenosis
Open accessAbstract
Objectives We sought to assess whether coronary stents have modified the predictive value of demographic, clinical and quantitative coronary angiographic (QCA) predictors of coronary restenosis.Background A systematic analysis in a large cohort of registries and randomized trials of the percutaneous transluminal coronary angioplasty (PTCA) and 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 six-month follow-up QCA analyses, were included in this study. Predictors of restenosis were identified with univariate and multivariate logistic regression 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 with additional stenting. In the univariate analysis, favorable predictors were previous coronary artery bypass graft surgery (CABG), stent use, stent length and a large pre-procedural minimal lumen diameter (pre-MLD); unfavorable predictors were weight, body mass index, diabetes mellitus, multi-vessel disease, lesion length and a high residual post-procedural diameter stenosis (post-DS). Predictors specific for the PTCA population were a large post-procedural MLD (post-MLD) as favorable and a severe pre-procedural DS (pre-DS) as unfavorable. Favorable predictors specific for the stent population were a large post-MLD and a large pre-procedural reference diameter (pre-RD). In the multivariate analysis, the best model included the following favorable predictors: stent use, a large post-MLD, previous CABG and the interaction 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 predictors of coronary restenosis between PTCA and stent populations. In the modern (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 large post-MLD (optimal result). Finally, a larger pre-RD became a favorable predictor with the advent of stenting.
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Prior studies have observed an association between diabetes and angiographic progression of coronary atherosclerosis.
“Prior studies have observed the association between diabetes and angiographic progression of coronary atherosclerosis.18 -22”
From Diabetes, the Metabolic Syndrome, and Angiographic Progression of Coronary Arterial Disease in Postmenopausal Women (2006) · cites this paper as [22]
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- Authors
- Mercado, N., Boersma, E., Wijns, W., Gersh, B. J., Morillo, C. A., de Valk, V., van Es, G.-A., Grobbee, D. E., & Serruys, P. W.
- Affiliations
- Academisch Ziekenhuis Rotterdam (NL)
- Onze Lieve Vrouwziekenhuis Hospital (BE)
- Mayo Clinic (US)
- University Medical Center Utrecht (NL)
- Corresponding author
- Boersma, Eric
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2001-09
- Volume
- 38
- Issue
- 3
- Pages
- 645-652
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W1732807904
- Cited by
- 175
- References
- 55
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 1 · 2022: 3 · 2021: 2 · 2020: 1 · 2018: 1 · 2016: 6 · 2015: 2 · 2014: 6 · 2013: 6 · 2012: 9
- FWCI
- 13.11
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Keywords
- coronary restenosis, coronary stents, percutaneous transluminal coronary angioplasty, quantitative coronary angiography, restenosis predictors, minimal lumen diameter, residual stenosis, reference diameter, coronary artery bypass grafting, diabetes mellitus, lesion length, multivessel coronary artery disease, body mass index
- MeSH terms
- Aged, Coronary Disease, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Recurrence, Stents, Angioplasty, Balloon, Coronary, Logistic Models, Coronary Angiography
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