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(Circulation. 1997;95:2244-2246.)
© 1997 American Heart Association, Inc.

Articles

Identifying the Predictors of Restenosis

Do We Need New Glasses?

David P. Faxon, MD

the Division of Cardiology, University of Southern California, Los Angeles.

Correspondence to David P. Faxon, MD, Professor of Medicine, Chief, Division of Cardiology, University of Southern California, School of Medicine, 1355 San Pablo St, Suite 117, Los Angeles, CA 90003. E-mail dfaxon@hsc.usc.edu

Key Words: Editorials • ultrasonics • restenosis

	Introduction

 
The ability to predict restenosis after coronary interventional procedures has remained remarkably difficult. A number of clinical, procedural, and angiographic factors have been reported to be related to subsequent risk of restenosis.^{1 2 3 4 5} These include sex, prior history of restenosis, diabetes, hyperlipidemia, hypertension, unstable angina, vasospastic angina, renal disease, and smoking. Procedural factors include balloon-to-artery ratio, presence of significant residual gradient, significant residual stenosis, and the extent of dissection. In addition, angiographic factors such as the size of the reference vessel, severity of the stenosis, presence of calcium, eccentric lesions, saphenous vein graft location, ostial or proximal lesion location, and left anterior descending lesion location, as well as chronic total occlusion and long lesions, have all been associated with a higher rate of restenosis on follow-up. However, when evaluated in large studies in which multivariate analyses were performed and complete angiographic follow-up was available, the predictive power of these variables was remarkably poor.^{1 2 3 4 5} In one recent study,⁵ only 30% of restenosis could be predicted from clinical, procedural, and angiographic variables. Of all the factors that have been analyzed, the most potent appears to be a large postprocedural lumen diameter. The consistency of this finding, regardless of the device used, has led to the current widely embraced strategy of angioplasty, namely that "bigger is better."⁴ It has been the principal explanation for the improved long-term outcome seen with coronary stenting and directional atherectomy and is responsible for the improved outcomes of angioplasty.^{6 7}

Nevertheless, further refinement in our ability to define those at . . . [Full Text of this Article]

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