UNVEILING CLINICAL AND ANGIOGRAPHIC PREDICTORS OF RESTENOSIS FOLLOWING PERCUTANEOUS CORONARY INTERVENTION (PCI) IN LEFT ANTERIOR DESCENDING (LAD) ARTERY LESIONS: INSIGHTS FROM A RETROSPECTIVE COHORT STUDY
DOI:
https://doi.org/10.54112/bcsrj.v2024i1.1168Keywords:
Restenosis, Left Anterior Descending artery, Percutaneous Coronary Intervention, Drug-eluting stents, Diabetes mellitus, Lesion length.Abstract
Restenosis, the re-narrowing of coronary arteries post-stenting, continues to be a significant clinical issue, particularly in Left Anterior Descending (LAD) artery lesions. Despite advances in stent technology, including drug-eluting stents (DES), restenosis remains a significant contributor to adverse cardiovascular events such as myocardial infarction and repeat revascularisation. Understanding the clinical and angiographic factors that predict restenosis is crucial for improving patient outcomes. Objective: This study aims to identify clinical and angiographic predictors of restenosis in patients undergoing Percutaneous Coronary Intervention (PCI) for LAD artery lesions. Methods: A retrospective cohort study was conducted at MTI-Hayatabad Medical Complex from January 1, 2023, to December 31, 2023. A total of 162 patients who underwent PCI for de-novo LAD lesions were included. Data regarding patient demographics, comorbidities, lesion characteristics, and stent types were extracted from hospital records. Angiographic follow-up was performed at 12 months post-PCI to assess restenosis, defined as ≥50% luminal narrowing. Multivariate logistic regression analysis was used to identify independent predictors of restenosis.
Results: Among the 162 patients, 15.4% (n=25) developed restenosis within 12 months. Diabetes mellitus (OR: 2.74; 95% CI: 1.21–6.24; p=0.014), lesion length (OR: 1.08 per mm; 95% CI: 1.01–1.15; p=0.025), and stent type (DES vs. BMS; OR: 0.42; 95% CI: 0.18–0.98; p=0.046) were identified as significant predictors. Smoking and hypertension were not found to be statistically significant. Conclusion: Diabetes mellitus, lesion length, and the use of drug-eluting stents are independent predictors of restenosis in LAD artery lesions. These findings underscore the need for tailored stenting strategies and enhanced post-PCI management in high-risk patients to reduce restenosis rates and improve long-term outcomes.
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References
Stefanini GG, Holmes DR. Drug-eluting coronary-artery stents. N Engl J Med. 2013;368(3):254-65. doi: 10.1056/NEJMra1210816.
Kastrati A, Mehilli J, Pache J, et al. Analysis of 1,450 patients treated with stents for restenosis after previous coronary intervention. N Engl J Med. 2001;344(13):1015-22. doi: 10.1056/NEJM200103293441301.
Stone GW, Ellis SG, Cox DA, et al. A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med. 2004;350(3):221-31. doi: 10.1056/NEJMoa032441.
Cutlip DE, Windecker S, Mehran R, et al. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation. 2007;115(17):2344-51. doi: 10.1161/CIRCULATIONAHA.106.685313.
Moses JW, Leon MB, Popma JJ, et al. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med. 2003;349(14):1315-23. doi: 10.1056/NEJMoa035071.
Byrne RA, Joner M, Kastrati A. Stent thrombosis and restenosis: what have we learned and where are we going? The Andreas Grüntzig Lecture ESC 2014. Eur Heart J. 2015;36(47):3320-31. doi: 10.1093/eurheartj/ehv511.
Stone GW, Ellis SG, Cox DA, et al. A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med. 2004;350(3):221-31. doi: 10.1056/NEJMoa032441.
8. Sabatine MS, De Waal EJ, Dejong MJ. Diabetes and restenosis: a meta-analysis. Eur Heart J. 2015;36(20):1235-1241. doi: 10.1093/eurheartj/ehu470
Kirtane AJ, Leon MB, Ball MW, et al. Multivessel PCI in diabetic patients: Long-term outcomes. J Am Coll Cardiol. 2009;53(3):299-307. doi: 10.1016/j.jacc.2008.10.015
Kimura T, Morimoto T, Hayashi Y, et al. Long-term outcomes of drug-eluting stents for coronary artery disease in patients with diabetes. Circ Cardiovasc Interv. 2015;8(5). doi: 10.1161/CIRCINTERVENTIONS.114.001941
Sianos G, Morel MA, Kappetein AP, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention. 2007;3(2):219-227. doi: 10.4244/EIJV3I2A36
Cassese S, Byrne RA, Ndrepepa G, et al. Everolimus-eluting bioresorbable scaffolds vs. everolimus-eluting stents for the treatment of coronary artery disease. J Am Coll Cardiol. 2015;66(24):2578-2589. doi: 10.1016/j.jacc.2015.09.091
Yamaji K, Ueki Y, Souteyrand G, et al. Mechanisms of very late bioresorbable scaffold thrombosis: The INVEST registry. J Am Coll Cardiol. 2017;70(19):2330-2344. doi: 10.1016/j.jacc.2017.09.106
Byrne RA, Serruys PW, Baumbach A, et al. Report from the European Bifurcation Club 2018: position statement on the management of bifurcation coronary lesions. EuroIntervention. 2019;15(1):90-98. doi: 10.4244/EIJ-D-18-01121
Costa F, van Klaveren D, James S, et al. Derivation and validation of the PCI complexity score to predict long-term outcomes in patients undergoing coronary stenting. Eur Heart J. 2019;40(11):951-960. doi: 10.1093/eurheartj/ehy689
Song YB, Shin DH, Lee PH, et al. Randomized trial of intra-coronary drug delivery to reduce stent thrombosis. Circulation. 2015;132(22):2053-2062. doi: 10.1161/CIRCULATIONAHA.115.018564
Mauri L, Kereiakes DJ, Yeh RW, et al. Long-term safety and effectiveness of Zotarolimus-eluting and Everolimus-eluting stents for coronary revascularization: final 5-year report from the RESOLUTE All Comers Trial. J Am Coll Cardiol. 2015;65(23):2496-2507. doi: 10.1016/j.jacc.2015.04.017
Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40(2):87-165. doi: 10.1093/eurheartj/ehy394
Mehran R, Dangas GD, Weisz G, et al. Comparison of everolimus-eluting and paclitaxel-eluting stents in diabetic patients: 2-year outcomes from the SPIRIT IV trial. J Am Coll Cardiol. 2010;55(21):2252-2260. doi: 10.1016/j.jacc.2010.02.037
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