Incidence and predictors of restenosis after sirolimus-eluting stent implantation in high-risk patients

Abstract

Sirolimus-eluting stents (SESs) have not been evaluated systematically in clinical scenarios or with the vascular morphologies associated with the highest rates of restenosis. Between May 2002 and August 2003, 1379 percutaneous interventions were carried out at our center, 231 with SES implantation in patients with complex coronary lesions: (1) left main trunk, (2) bifurcations, (3) long lesions, (4) calcified lesions, (5) proximal segment of the left anterior descending coronary, (6) restenotic lesions, (7) total occlusions, (8) ostial lesions, and (9) vessels < 2.75 mm. Angiographic follow-up was carried out in the 6th month in 201 patients. Clinical, angiographic, and procedural variables were analyzed to assess predictors of restenosis. Of the patients, 42.6% were diabetic and 20.2% were insulin dependent. A total of 263 lesions was treated. Mean lesion length was 16.5 +/- 11 mm and mean vessel diameter was 2.54 +/- 0.7 mm. A total of 327 stents was implanted to fully cover the entire lesion, in most cases after predilatation (89.1%). The mean segment length covered by the stent was 26 +/- 12 mm and the stent length/lesion length ratio was 1.7 +/- 0.9. Binary restenosis was found in 8.7%, but there was no edge restenosis. The only predictors of restenosis were female sex (OR 3.44, 95% CI 1.31-8.99, P = .011) and lesion length > 30 mm (OR 3.39, 95% CI 1.07-10.77, P = .038). In scenarios that usually entail high restenotic risk in patients with conventional stent implantation, SESs had a low incidence of restenosis without edge complications.