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(Circulation. 2006;113:2293-2300.)
© 2006 American Heart Association, Inc.

Interventional Cardiology

Predictive Factors of Restenosis After Coronary Implantation of Sirolimus- or Paclitaxel-Eluting Stents

Adnan Kastrati, MD; Alban Dibra, MD; Julinda Mehilli, MD; Sandra Mayer, RN; Susanne Pinieck, RN; Jürgen Pache, MD; Josef Dirschinger, MD; Albert Schömig, MD

From Deutsches Herzzentrum (A.K., A.D., J.M., S.M. S.P., J.P., A.S.) and First Medizinische Klinik rechts der Isar (J.D., A.S.), Technische Universität, Munich, Germany.

Correspondence to Adnan Kastrati, MD, Deutsches Herzzentrum, Lazarettstrasse 36, 80636 Munich, Germany. E-mail kastrati{at}dhm.mhn.de

Received November 15, 2005; revision received February 10, 2006; accepted February 24, 2006.

Background— The efficacy of drug-eluting stents in reducing restenosis risk has not been uniform across patient subsets. Identifying predictive factors of restenosis may help improve outcomes after percutaneous coronary interventions.

Methods and Results— All patients who underwent successful implantation of sirolimus- or paclitaxel-eluting stents in native vessels for de novo lesions between August 2002 and December 2004 were eligible for this study. All data were prospectively collected. Angiographic restenosis was defined as diameter stenosis 50% at follow-up in the in-segment area. Target lesion revascularization was defined as any revascularization procedure involving the target lesion. Included in this study were 1845 patients with 2093 target lesions. Multivariable analysis showed that vessel size, final diameter stenosis, and drug-eluting stent type were the strongest predictors of restenosis. A 0.5-mm decrease in vessel size was associated with adjusted odds ratios (ORs) of 1.74 (95% CI, 1.31 to 2.32) for angiographic restenosis and 1.65 (95% CI, 1.22 to 2.23) for target lesion revascularization. A 5% increase in final diameter stenosis was associated with adjusted ORs of 1.30 (95% CI, 1.15 to 1.47) for angiographic restenosis and 1.18 (95% CI, 1.03 to 1.35) for target lesion revascularization. Compared with paclitaxel-eluting stent, sirolimus-eluting stent was associated with adjusted ORs of 0.60 (95% CI, 0.44 to 0.81) for angiographic restenosis and 0.67 (95% CI, 0.49 to 0.91) for target lesion revascularization.

Conclusions— Vessel size and drug-eluting stent type are the most important predictors of angiographic and clinical restenosis, with drug-eluting stent type having a particular impact on restenosis of small coronary vessels.

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CLINICAL PERSPECTIVE

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