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49th Annual Scientific Session of the American College of Cardiology, March 2000, Anaheim, California
- Predictors of Recurrent In-Stent Restenosis Following Mechanical Treatment by Angioplasty or Rotational Atherectomy: Results From an Angiographically Controlled Prospective Trial (ARTIST Study).
- J. vom Dahl, P. K. Haager, T. Reineke, U. Dietz, S. Silber, E. Niccoli, H. J. Büttner, F. Schiele, M. Thomas, F. Commeau, T. Ramsdale, E. Garcia, H. G. Klues
- J Am Coll Cardiol 35: 83A (2000)
Background: Diffuse in-stent restenosis (ISR) with high recurrence rates remains a challenging problem for which the best mechanical treatment is not clear. We sought to evaluate clinical and angiographic predictors of recurrent restenosis from an angiographically controlled prospective study (ARTIST study).
Methods and Results: Angiographic follow-up with quantitative coronary angiographic analysis is available in 259/269 eligible patients randomized to either balloon angioplasty (PTCA) or rotational atherectomy (ROTA) for diffuse ISR (10-50 mm length). A logistic regression analysis was performed for restenosis (>50% diameter stenosis (DS) at follow-up) as the dependent variable using univariate and multiveriate models with 15 clinical and angiographic variables.
Variable Univariate model
Multivariate model
Odds ratio
p
Odds ratio
p
Diabtes (O=no) 1.67
0.09
1.44
0.30
T (0=PTCA, 1=Rota) 1.75
0.03
1.64
0.10
Lesion length (mm) 1.09
0.0003
1.08
0.001
% DS pre T 1.05
0.0001
1.06
0.0008
MLD post T 0.41
0.02
0.8
0.65
MLD = minimal luminal diameter, T = treatment of ISRConclusion: In this angiographically controlled prospective study baseline lesion length defined as length of first in-stent restenosis (>50% DS) and baseline diameter were the most powerful predictors of recurrent restenosis after mechanical treatment. This indicates that the in-stent tissue volume at first ISR seems to be the most important predictor of angiographic long-term outcome.
