Abstract 3041: Calcification in Target Lesion and Stent-delivery Pathway as Important Determinant for Coronary Restenosis after Sirolimus-Eluting Stent Implantation: Calcification Score Analysis
Background: Many randomized studies demonstrated that sirolimus-eluting stent (SES) significantly reduced restenosis following percutaneous coronary intervention. However, it remains unknown about the impact of coronary artery calcification on the efficacy of SES.
Methods: To investigate the association between in-stent restenosis after SES and coronary artery calcification, we studied 342 patients with angina pectoris. The intensity of coronary calcification was assessed by angiographic scoring system as follows; 0:none, 1:blocky or spotty calcification, 2:linear calcification compromising one-side of arterial lumen, 3:linear calcification compromising both-sides of arterial lumen found unidirectionally, 4:linear calcification compromising both-sides of arterial lumen found bidirectionally, 5:blanket/circumferential and dense calcification.
Results: Restenosis was found in 17 patients (5%) by follow-up angiography. In spite of similar stent size, inflated pressure and post-SES minimum lesion diameter, target lesion- and stent-delivery-pathway calcification score were significantly higher in patients with restenosis than those without it (Figure⇓). In multivariate analysis, target lesion-and stent-delivery-pathway calcification score was independently associated with restenosis (a hazard ratio: 44.08, 6.13, respectively, p<0.01).
Conclusions: These findings indicate that coronary artery calcification in target lesion and stent-delivery pathway is an important determinant for post-SES restenosis. This may be partly related to polymer peeling of the coating surface, decreasing sirolimus release concentration.