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      Short Stent Implantation for Routine Use Is Feasible in a High Proportion of Coronary Interventions and Yields a Low Restenosis Rate

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          Stent length predicts restenosis. The feasibility of using a short stent (<10 mm) routinely was investigated in 331 consecutive patients treated for 424 coronary artery lesions. A single short stent provided suitable coverage and achieved a residual stenosis <30%, with or without predilatation, in 252/424 lesions (59.4%). Longer stents were implanted in 58/424 lesions (13.7%), while only percutaneous transluminal coronary angioplasty was performed in 114/242 lesions (26.9%). Angiographic success and procedural success were achieved in 250/252 lesions (99.2%). Restenosis occurred in 36/231 lesions (15.6%) after short stenting, in 10/53 lesions (18.9%) after long stents, in 21/88 lesions (23.9%) after percutaneous transluminal coronary angioplasty, and in 67/372 lesions (18.0%) controlled angiographically. Only small vessel diameter predicted restenosis after short stenting. Thus, a single short stent implanted directly or after predilatation is sufficient to achieve an acceptable angiographic result in more than in nearly 60% of all treated lesions. Short stenting results in a low restenosis rate.

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          Diabetes mellitus and the clinical and angiographic outcome after coronary stent placement.

          The objectives of this study were to analyze the clinical and angiographic outcome of diabetic patients with successful coronary stent placement and to compare these results with those achieved after stenting in nondiabetic patients. The outcome of diabetic patients treated with stent placement due to coronary artery disease has not been assessed comprehensively. This study analyzes a consecutive series of patients with successful stent placement comprising 715 patients with diabetes and 2,839 patients without diabetes. Clinical one year follow-up and angiographic control at 6 months were part of the protocol. Death, myocardial infarction and target lesion revascularization were considered as adverse events. An automated edge detection system was used for the angiographic assessment. The primary clinical endpoint was event-free survival at one year. The primary angiographic endpoint was restenosis rate at 6 months (> or = 50% diameter stenosis). Event-free survival was significantly lower in diabetic than in nondiabetic patients (73.1 vs. 78.5%, p < 0.001). Survival free of myocardial infarction was also significantly reduced in the diabetic group (89.9 vs. 94.4% in nondiabetics, p < 0.001). The incidence of both restenosis (37.5 vs. 28.3%, p < 0.001) and stent vessel occlusion (5.3 vs. 3.4%, p = 0.037) was significantly higher in diabetic patients. Diabetes was identified as an independent risk factor for adverse clinical events and restenosis in multivariate analyses. Patients with diabetes mellitus have a less favorable clinical outcome at one year after successful stent placement as compared to the nondiabetic patients. The clinical follow-up was characterized by a higher incidence of death, myocardial infarction and reinterventions. Diabetic patients also demonstrated an increased risk for restenosis.
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            Predictive factors of restenosis after coronary stent placement.

            The objective of this study was to identify clinical, lesional and procedural factors that can predict restenosis after coronary stent placement. Coronary stent placement reduces the restenosis rate compared with that after percutaneous transluminal coronary angioplasty (PTCA). However, restenosis remains an unresolved issue, and identification of its predictive factors may allow further insight into the underlying process. All patients with successful coronary stent placement were eligible for this study unless they had had a major adverse cardiac event during the 1st 30 days after the procedure. Of the 1,349 eligible patients (1,753 lesions), follow-up angiography at 6 months was performed in 80.4% (1,084 patients, 1,399 lesions). Demographic, clinical, lesional and procedural data were prospectively recorded and analyzed for any predictive power for the occurrence of late restenosis after stenting. Restenosis was evaluated by using three outcomes at follow-up: binary restenosis as a diameter stenosis > or =50%, late lumen loss as lumen diameter reduction and target lesion revascularization (TLR) as any repeat PTCA or coronary artery bypass surgery involving the stented lesion. Multivariate analysis demonstrated that diabetes mellitus, placement of multiple stents and minimal lumen diameter (MLD) immediately after stenting were the strongest predictors of restenosis. Diabetes increased the risk of binary restenosis with an odds ratio (OR) [95% confidence interval] of 1.86 [1.56 to 2.16] and the risk of TLR with an OR of 1.45 [1.11 to 1.80]. Multiple stents increased the risk of binary restenosis with an OR of 1.81 [1.55 to 2.06] and that of TLR with an OR of 1.94 [1.66 to 2.22]. An MLD <3 mm at the end of the procedure augmented the risk of binary restenosis with an OR of 1.81 [1.55 to 2.06] and that of TLR with an OR of 2.05 [1.77 to 2.34]. Classification and regression tree analysis demonstrated that the incidence of restenosis may be as low as 16% for a lesion without any of these risk factors and as high as 59% for a lesion with a combination of these risk factors. Diabetes, multiple stents and smaller final MLD are strong predictors of restenosis after coronary stent placement. Achieving an optimal result with a minimal number of stents during the procedure may significantly reduce this risk even in patients with adverse clinical characteristics such as diabetes.
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              Clinical restenosis after coronary stenting: perspectives from multicenter clinical trials.

              We sought to evaluate clinical restenosis in a large population of patients who had undergone coronary stent placement. One-year success after coronary stenting is limited mainly by restenosis of and requirement for repeat revascularization of the treated lesion. We studied 6,186 patients (6,219 lesions) pooled from several recently completed coronary stent trials. Clinical restenosis was defined using three different definitions: target lesion revascularization (TLR) beyond 30 days, target vessel revascularization (TVR) beyond 30 days, and target vessel failure (TVF), defined as TVR, any death, or myocardial infarction (MI) of the target vessel territory after hospital discharge. By one year, 638 (12.2%) patients had TLR, 748 (14.3%) had TVR, and 848 (16.0%) had TVF, more than two-thirds higher than the rate of these end points at six months. The severity of angiographic restenosis (> or =50% follow-up diameter stenosis [DS]) in 419 of 1,437 (29%) patients undergoing routine angiographic follow-up correlated directly with the likelihood of TLR (73% vs. 26% for >70% DS compared with <60% DS). Smaller pretreatment minimum lumen diameter (MLD), smaller final MLD, longer stent length, diabetes mellitus, unstable angina, and hypertension were independent predictors of TLR. Prior MI and current smoking were negative predictors. At one year after stenting, most clinical restenosis reflected TLR, which was predicted by the same variables previously associated with an increased risk of angiographic restenosis. The lower absolute rate of clinical restenosis relative to angiographic restenosis was due to infrequent TLR in lesions with less severe (<60% DS) angiographic renarrowing.

                Author and article information

                S. Karger AG
                June 2005
                10 June 2005
                : 103
                : 4
                : 212-218
                aGerman Clinic for Diagnostics, Wiesbaden, and bCoordination Center for Clinical Studies, University of Mainz, Mainz, Germany
                85200 Cardiology 2005;103:212–218
                © 2005 S. Karger AG, Basel

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                Page count
                Figures: 1, Tables: 6, References: 21, Pages: 7
                Cardiac Catheterization and Interventional Cardiology


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