Factors Associated with Development of in Coronary Stent Restenosis — the Results of a Multislice Computed Tomography 1-year Follow-up Study

Open access

Abstract

Introduction: Percutaneous coronary intervention is the first therapeutic choice in the treatment of symptomatic coronary artery disease and Multi-Slice Computed Tomography Coronary Angiography (MSCT-CA) is a new non-invasive diagnostic tool in the follow-up of these patients. The aim of our study was to evaluate the rate of in-stent restenosis (ISR), to identify the predictive factors for ISR at 1 year after PCI and to assess the progression of non-culprit lesions, using a MSCT-CA follow-up.

Material and methods: The study included 30 patients with acute coronary syndrome treated with one BMS implantation. The patients were divided into Group A (9 patients) presenting ISR and Group B (21 patients) without ISR at 1 year MSCT-CA follow-up.

Results: ISR lesions were mostly localized on the LAD (45%). No significant difference between the study groups was identified for risk factors, as male gender (77.7% vs. 85.71%, p = 0.62), hypertension (88.8% vs. 95.23%, p = 0.51), smoking status (33.3% vs. 72.22%, p = 0.23), history of CVD (55.5% vs. 47.61%, p >0.99), diabetes (11.11% vs. 19.04%, p >0.99), hyperlipidemia (22.22% vs. 52.38%, p = 0.22), CKD (44.44% vs. 14.28%, p = 0.15), age, triglycerides and SYNTAX Score. A significant difference was recorded in baseline cholesterol level (141.7 ± 8.788 vs. 182.8 ± 12; p = 0.029). Ca Score at 1 year was significantly higher in patients with ISR (603.1 ± 529.3 vs. 259.4 ± 354.6; p = 0.005). 66.67% of patients from Group A presented significant non-culprit lesions at baseline vs. 23.81% in Group B (p = 0.041).

Conclusions: MSCT-CA is a useful non-invasive diagnostic tool for ISR in the follow-up of patients who underwent primary PCI for an acute coronary syndrome. The presence of significant non-culprit lesions at the time of the primary PCI could be a predictive factor for ISR. A Ca Score >400 determined at 1-year follow-up is associated with a higher rate of ISR, and could be considered a significant cardiovascular risk factor for this group of patients. Further studies are required in order to elucidate the role of various imaging biomarkers in predicting the development of ISR.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. Windecker S Kolh P Alfonso F et al. 2014 ESC/EACTS Guidelines on myocardial revascularization. The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2014;35(37):2541-2619.

  • 2. Farooq V Gogas BD Serruys PW. Restenosis Delineating the Numerous Causes of Drug-Eluting Stent Restenosis. Circ Cardiovasc Interv. 2011;4(2):195-205.

  • 3. Topol E J Teirstein P S. Textbook of Interventional Cardiology. 6th Edition. Philadelphia. Elsevier Saunders; 2011. pg. 421-432

  • 4. Mitra AK Agrawal DK. In stent restenosis: bane of the stent era. J Clin Pathol. 2006;59:232-239.

  • 5. Park SJ1 Kang SJ Virmani R Nakano M Ueda Y. In-Stent Neoatherosclerosis A Final Common Pathway of Late Stent Failure. J Am Coll Cardiol. 2012;59(23):2051-2057.

  • 6. Chen MS John JM Chew DP Lee DS Ellis SG Bhatt DL. Bare metal stent restenosis is not a benign clinical entity. Am Heart J. 2006;151:1260-1264.

  • 7. Cademartiri F Maffei E Palumbo E et al. CT coronary angiography for the follow-up of coronary stent. Acta Biomed. 2010;81(2):87-93.

  • 8. T. Ichihashi T. Kurita D. Yokota et al. Prognostic significance of follow up CT coronary angiography for the patients after percutaneous coronary intervention compared to invasive coronary angiography. Eur Heart J. 2013;34:P4782.

  • 9. Kastrati A Schömig A Elezi S et al. Predictive Factors of Restenosis After Coronary Stent Placement. J Am Coll Cardiol. 1997;30(6):1428-1436.

  • 10. Koskinas KC Chatzizisis YS Antoniadis AP Giannoglou GD. Role of endothelial shear stress in stent restenosis and thrombosis: pathophysiologic mechanisms and implications for clinical translation. J Am Coll Cardiol. 2012 Apr 10;59(15):1337-1349.

  • 11. Stone NJ Robinson JG Lichtenstein AH et al. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. J Am Coll Cardiol. 2014;63(25 Pt B):2889-2934.

  • 12. Shaw LJ Raggi P Schisterman E Berman DS Callister TQ. Prognostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality. Radiology. 2003;228(3):826-833.

  • 13. Nakazawa G Otsuka F Nakano M et al. The pathology of neoatherosclerosis in human coronary implant bare-metal and drug-eluting stents. J Am Coll Cardiol. 2011;57:1314-1322.

  • 14. Motoyama S Sarai M Harigaya H. Computed Tomographic Angiography Characteristics of Atherosclerotic Plaques Subsequently Resulting in Acute Coronary Syndrome. J Am Coll Cardiol. 2009;54:49-57.

  • 15. Benedek T Gyongyosi M Benedek I. Multislice Computed Tomographic Coronary Angiography for Quantitative Assessment of Culprit Lesions in Acute Coronary Syndromes. Canadian J Cardiol. 2013;29:364-371.

Search
Journal information
Metrics
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 184 94 2
PDF Downloads 97 62 2