Predictors of angiographic restenosis after drug eluting stents in the coronary arteries: contemporary practice in real world patients

Aims: Drug eluting stents (DES) have been used routinely in a wide variety of clinical situations. The impact of DES on reducing restenosis has not been uniform across complex subsets and limited data is available examining predictors of restenosis in unselected population. Methods and results: We investigated predictors of angiographic restenosis in an unselected population. The study population consisted of 4,143 lesions and angiographic follow-up was available for 3,020(73%) lesions in 1,885 patients. The intravascular ultrasound (IVUS) was used in 95% of the patients during the procedure. Angiographic restenosis was seen in 339 (11.2%) lesions and target lesion revascularisation was performed in 290 (9.6%) lesions. The patient population included large numbers of renal failure patients on haemodialysis, ISR, and Type C lesions with routine use of intravascular ultrasound. We identified diabetes mellitus, renal failure, Type C lesions, calcified lesion, tortuous lesion, ISR, long lesion, small baseline diameter and final vessel diameter as predictors of restenosis. On multivariate analysis diabetes (OR 1.45, 95% Cl 1.07-1.97, p= 0.01), renal failure on haemodialysis (OR 2.02, 95% Cl 1.37-3.27, p=0.001), ISR (OR 3.56, 95% Cl 2.16-5.89, P<0.001), lesion length (OR 1.02, CI 1.01-1.03.P<0.001), reference vessel diameter (OR 0.50, 95% CI 0.31-0.80, p=0.005) and post-intervention IVUS lumen area (p<0.001) were independent predictors of angiographic restenosis. Female gender (OR 0.61, 95% Cl 0.410.91, p=0.015) was found to have a negative correlation for ISR. We did not find any significant difference in restenosis between the usage of sirolimus and paclitaxel eluting stents. Conclusions: DES usage was associated with overall low in-stent restenosis and we have identified several clinical, angiographic, and IVUS predictors of angiographic restenosis in unselected patients with complex anatomy.