薬剤溶出ステント留置術施行後にステント内再狭窄または‌新規病変に追加的な経皮的冠動脈インターベンションが必要となった患者における臨床的リスク因子の検討

Abstract

Percutaneous coronary intervention (PCI) with drug-eluting stent (DES) and appropriate antiplatelet therapy is a standard therapeutic procedure for patients who develop ischemic heart events. While the incidence of restenosis with DES is much less than that with bare metal stents, additional PCI for in-stent restenosis or de novo lesions is still required for some patients in clinical practice. In the present study, we performed a retrospective medical chart review for assessing clinical risk factors associated with the additional PCI in DES-implanted patients. Among 358 DESimplanted patients, 143 required additional PCI (75 in-stent restenosis in 75 and 82 de novo lesions) from 6 to 12 months after PCI. Logistic regression analysis revealed that female, multiple stenosis (double/triple vessels) and HbA1c at PCI are significant variables for predicting secondary PCI with odds ratios [95% confidence intervals] of 0.46 [0.25 to 0.85] (relative to male), 2.3/3.6 [1.2 to 4.4/1.9 to 6.8] (relative to single vessel disease) and 1.2 [1.0 to 1.4] (per 1% increment), respectively. When analysis was performed for in-stent restenosis and de novo lesion, separately, multiple stenosis was a significant risk factor for both groups. Interestingly, intensive blood glucose management after PCI was not associated with a significant reduction in the likelihood of additional PCI in overall patients as well as a subgroup of diabetic patients with inappropriate glycemic control (HbA1c ≥6.5%). We concluded that the management of HbA1c in high-risk patients of coronary diseases is the sole modifiable risk factor for reducing the incidence of additional PCI after DES stenting.