Abstract 3245: Non-Focal Restenosis is Associated with Paclitaxel-Eluting Stents, Women and Overlapping Stents
BACKGROUND: There is a common perception based on reports of limited numbers of restenotic lesions that restenosis after drug-eluting stent implantation is predominantly focal. However, in our experience non-focal restenosis not only occurs in drug-eluting stents but continues to carry an increased risk of both restenosis and re-intervention.
AIM: To evaluate the incidence of, and factors associated with, non-focal restenosis following implantation of sirolimus- and paclitaxel-eluting stents in comparable unselected lesions in contemporary practice.
METHODS: We classified all episodes of angiographic restenosis which occurred after paclitaxel-eluting (PES) or sirolimus-eluting stent (SES) implantation in de novo lesions. Restenosis pattern was classified as focal, diffuse, proliferative or occlusive. Factors associated with the pattern of restenosis were examined by univariate, multi-variate and propensity analyses.
RESULTS: 1376 lesions in 803 patients were treated with SES and 1199 lesions in 692 patients treated with PES between March 2003 and March 2005. There were no significant differences in major clinical or lesion characteristics between the two groups. Follow-up angiography was performed in 68.3% of SES patients vs. 72.0% of PES patients (p=0.194). 150 and 149 restenotic lesions were characterized in the SES and PES groups respectively. The incidence of diffuse and occlusive (non-focal) restenosis was significantly higher in PES than SES (47.6% vs. 27.0%, p<0.001). The incidence of proliferative restenosis was low for both stents (0.7% in each). Multivariate (OR 2.528, 95% CI 1.394 – 4.586, p=0.002) and propensity (OR 2.19, 95% CI 1.273–3.752, p=0.005) analyses confirmed the positive association of PES with non-focal restenosis. Furthermore, female gender (OR 4.51, 95% CI 2.055–9.907, p<0.001) and the use of overlapping stents (OR 3.47, 95% CI 1.658–7.244, p<0.001) were also independently associated with non-focal restenosis.
CONCLUSIONS: Non-focal restenosis is independently associated with PES, female gender and the use of overlapping stents. Nevertheless, focal restenosis remains the predominant pattern in both SES and PES.