Influence of a pressure gradient distal to implanted bare-metal stent on in-stent restenosis after percutaneous coronary intervention

Lisette Okkels Jensen, Per Thayssen, Leif Thuesen, Henrik Steen Hansen, Jens Flensted Lassen, Henning Kelbaek, Anders Junker, Knud Noerregaard Hansen, Hans Erik Boetker, Lars Romer Krusell, Knud Erik Pedersen

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    Abstrakt

    BACKGROUND - Fractional flow reserve predicts cardiac events after coronary stent implantation. The aim of the present study was to assess the 9-month angiographic in-stent restenosis rate in the setting of optimal stenting and a persisting gradient distal to the stent as assessed by a pressure wire pullback recording in the entire length of the artery. METHODS AND RESULTS - In 98 patients with angina pectoris, 1 de novo coronary lesion was treated with a bare-metal stent. After stent implantation, pressure wire measurements (Pd=mean hyperemic coronary pressure and Pa=mean aortic pressure) were performed in the target vessel: (1) Pd/Pa as distal to the artery as possible (fractional flow reserve per definition); (2) Pd/Pa just distal to the stent; (3) Pd/Pa just proximal to the stent; and (4) Pd/Pa at the ostium. Residual abnormal Pd/Pa was defined as a pressure drop between Pd/Pa measured at points 1 and 2. Fractional flow reserve distal to the artery after stenting was significantly lower (0.88±0.21 versus 0.97±0.05; P<0.001), and angiographic in-stent binary restenosis rate was significantly higher (44.0% versus 8.1%; P<0.001) in vessels with a residual abnormal Pd/Pa. Residual abnormal Pd/Pa (odds ratio, 4.39; 95% confidence interval, 1.10 to 18.16; P=0.034), reference vessel size (odds ratio, 0.17; 95% confidence interval, 0.04 to 0.69; P=0.013), and stent length (odds ratio, 1.11; 95% confidence interval, 1.03 to 1.21; P=0.009) were predictors of angiographic in-stent restenosis after 9 months. CONCLUSIONS - A residual abnormal Pd/Pa distal to a bare-metal stent was an independent predictor of in-stent restenosis after implantation of a coronary bare-metal stent.

    OriginalsprogEngelsk
    Sider (fra-til)2802-2808
    Antal sider7
    TidsskriftCirculation
    Vol/bind116
    Udgave nummer24
    DOI
    StatusUdgivet - 1 dec. 2007

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    Udforsk hvilke forskningsemner 'Influence of a pressure gradient distal to implanted bare-metal stent on in-stent restenosis after percutaneous coronary intervention' indeholder.

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