Odds Ratio Of Restenosis Research Articles

An increase in HbA1c after percutaneous coronary intervention raises the risk for restenosis in patients without Type 2 diabetes mellitus

The influence of dynamic changes in glycated haemoglobin (HbA(1c)) on restenosis after elective percutaneous coronary intervention (PCI) in patients without diabetes has not been analysed. Therefore, the rate of restenosis was investigated after elective PCI in 101 consecutive patients without diabetes mellitus in relation to dynamic changes of HbA(1c) levels. Follow-up angiography was performed in all patients 4-6 months after intervention. Multivariate analysis demonstrated that the change in HbA(1c) between first and second coronary angiography was the most powerful metabolic parameter for prediction of restenosis. The odds ratio for restenosis was 3.0 (95% CI 1.0-9.0) for any increase in HbA(1c) and 1.9 (95% CI 1.1-3.5) for an HbA(1c) increase of 0.2%. Hence, chronic changes in the glucometabolic environment influence the incidence of restenosis after PCI in patients without diabetes.

High P-selectin expression and low CD36 occupancy on circulating platelets are strong predictors of restenosis after coronary stenting in patients with coronary artery disease

Recent studies have shown that circulating platelets play an important role in the development of restenosis early after coronary stent implantation. We investigated P-selectin expression and CD36 blockade on platelets by flow cytometry in 48 consecutive patients who underwent coronary stenting. P-selectin expression was significantly higher 1 day after stenting in patients who had restenosis (n = 15) than in those who had no restenosis (n = 28), and the odds ratio for restenosis in patients with high P-selectin levels (MFI > 6.5) was 11.67 (P < 0.001) as compared with patients who had intermediate and low P-selectin levels. CD36 blockade was assessed with the use of two anti-CD36 antibodies, OKM5 and GS95 (our new anti-CD36 antibody), the binding of which indicates total CD36 amount and free CD36 unoccupied by lipid-related ligands, respectively. Binding of OKM5 to platelets was similar before and after stenting in both groups. CD36 blockade on platelets was seen 1 day after stenting in the non-restenosis group, and the odds ratio for restenosis in patients without CD36 blockade [GS95 binding ratio >0.8 as compared with binding before stenting] on day 1 was 28.60 (P < 0.001). P-selectin expression and unoccupied CD36 on platelets shortly after stenting may be strong predictors of post-stent restenosis.

Drug-eluting stents: meta-analysis in diabetic patients

2A recent meta-analysis of six trials in patients receiving coronary angioplasty with bare-metal stents (BMS) reported that the odds ratio (OR) of restenosis associated with diabetes was 1.61 (95% CI 1.21-2.14, p = 0.004). 3 As DES significantly reduce restenosis rates, 4 especially in small vessels, it would be interesting to specifically analyse the potential impact of DES in diabetic patients. We performed a meta-analysis of the results from six recent trials comparing DES and BMS, using sirolimus (RAVEL, SIRIUS and E-SIRIUS) or paclitaxel (TAXUS II, TAXUS IV and TAXUS VI). These trials provided adequate figures which allowed us to recalculate the rate of in-stent restenosis (defined as a stenosis ≥ 50%) after a follow-up of 6-12 months in both diabetic (around 20% of the population) and non-diabetic patients (Fig. 1 ). OR of restenosis was markedly lower when comparing DES with BMS and similar in both non-diabetic (OR: 0.16; 0.12-0.20; p <0.00001) and diabetic (OR: 0.16; 0.11-0.24; p <0.00001) patients. However, as compared to non-diabetic individuals, the OR of in-stent restenosis associated with diabetes still averaged 1.96 (1.28-3.01) in the groups receiving DES (p = 0.002), a figure quite similar (although less consistent between studies) to that observed with BMS (OR = 1.90; 1.49-2.43; p <0.00001). Interestingly, in the SIRIUS substudy specifically devoted to diabetes, 5 in-lesion restenosis was significantly reduced with DES compared to BMS in the noninsulin-requiring patients (7.7% vs. 49.3%, p < 0.001 ), but not in the insulin-requiring patients (35% vs. 50%, p = 0.38). MACE incidence after 9 months was reduced from 25% with BMS to 9.2% with DES (p < 0.001 ) in diabetic patients and from 16.5% to 6.5% (p < 0.001) in non-diabetic patients, respectively. Finally, in the RESEARCH registry of DES use in the real world, 6 diabetes was a significant predictor of MACE (OR =1.62; 1.09-2.43; p = 0.02), especially clinically driven target vessel revascularization (OR =1.81; 1.10-2.99; p = 0.02). In conclusion, DES are associated with a 80% remarkable relative risk reduction of restenosis during the first year of follow-up in diabetic patients as compared to BMS, similar to that observed in non-diabetic subjects. However, despite the use of DES, diabetes mellitus still remains an independent risk factor of restenosis, need for revascularization and MACE. Further specific prospective studies with highly effective DES should be performed in this high risk diabetic population.

The Timing of the Reflected Wave in the Ascending Aortic Pressure Predicts Restenosis after Coronary Stent Placement

It has been reported that the reflection waveform in the ascending aortic pressure is associated with systemic arterial stiffness. Stiffening of the aortic walls leads to a decrease in coronary perfusion and an increase in restenosis rate. The purpose of this study was to evaluate whether the reflection waveform in the ascending aortic pressure could be used to predict restenosis after percutaneous coronary stenting. One hundred and three patients who underwent percutaneous coronary stenting were enrolled in this study. We measured the inflection time and augmentation index (AIx) to determine the reflection waveform in the ascending aortic pressure at angioplasty. We then prospectively investigated the effect of inflection time and AIx in relation to the subsequent risk of restenosis after coronary stenting. After adjustments for age, gender, smoking habits, hypertension, type 2 diabetes, hypercholesterolemia, stent size, and heart rate, the odds ratio of restenosis in inflection time was 4.62 (95% confidence interval (CI), 1.39 to 15.4) for the lowest tertile of the inflection time level compared with the highest tertile level. As for AIx, the odds ratio of restenosis was 6.96 (95% CI, 1.93 to 25.1) for the highest tertile of the AIx level compared with the lowest tertile level. Inflection time and AIx are related to restenosis after percutaneous coronary stenting.

An updated meta-analysis of calcium-channel blockers in the prevention of restenosis after coronary angioplasty

Background In 1994, a meta-analysis of 5 small randomized trials reported a 30% reduction in the odds of angiographic restenosis when calcium-channel blockers (CCB) were given after percutaneous coronary intervention. Recently, the results of 2 large similar trials (Nisoldipine In Coronary Artery Disease in Leuven [NICOLE], and Coronary AngioPlasty Amlodipine in REstenosis Study [CAPARES]) were published. An extended meta-analysis including the results of the latter trials was performed. Methods A total of 2380 patients were analyzed. Statistical analysis included calculation of odds ratios for each trial, common odds ratio, and homogeneity for treatment effects across trials. Results The incidence of angiographic restenosis was 36% in the CCB-treated group and 42% in the placebo group. The odds ratio of restenosis with CCB therapy was 0.78 (95% CI 0.64-0.95) compared with control patients ( P = .01). Treatment effects were homogeneous across the trials. For the combined end point of death, coronary artery bypass grafting, repeat percutaneous transluminal coronary angioplasty, and myocardial infarction, 126 of 626 events occurred in the CCB group and 191 of 655 in the placebo group (odds ratio 0.61 [95% CI 0.47-0.80], P < .001). Conclusions This extended meta-analysis confirmed a reduction in the odds of restenosis and clinical events when CCBs were added to standard therapy after percutaneous coronary intervention. (Am Heart J 2003; 145:404-8.)

Inflection point of ascending aorticwaveform is a powerful predictor ofrestenosis after percutaneous transluminal coronary angioplasty

Background Although it was reported that the pulsatility of ascending aortic pressure is closely related to restenosis after percutaneous transluminal coronary angioplasty (PTCA), it is not known whether the reflection period of ascending aortic pressure can predict restenosis after PTCA. The purpose of this study was to evaluate whether reflection in the arterial system can be used to predict restenosis after PTCA. Methods We used the inflection point as the reflection period index and measured the coronary artery diameter, aortic pressure, and inflection time before PTCA. We defined the inflection time as the time interval from the initiation of systolic pressure waveform to the inflection point. We prospectively investigated the effect of inflection time in relation to the subsequent risk of restenosis after PTCA in patients with coronary artery disease. Results Crude cumulative incidence rates of restenosis were 74.1% for the lowest, 33.3% for the middle, and 26.1% for the highest tertile of inflection point levels. After adjustments for age, gender, smoking habits, hypertension, type 2 diabetes, hypercholesterolemia, old myocardial infarction, vessel location, post-minimal lumen diameter, heart rate, and ejection fraction, the odds ratio of restenosis was 6.99 (95% confidence interval, 1.54 to 31.7) for the lowest tertile of the inflection time level compared with the highest tertile level. Conclusions Inflection time is a powerful predictor of restenosis after PTCA.

Pulsatility of Ascending Aortic Pressure Waveform Is a Powerful Predictor of Restenosis After Percutaneous Transluminal Coronary Angioplasty

Because ascending aortic pressure has a greater effect on coronary perfusion during diastole than systole, we hypothesized that a high coronary diastolic-to-systolic pressure ratio prevents coronary lesions from restenosing after percutaneous transluminal coronary angioplasty (PTCA) and that ascending aortic pulsatility relative to mean pressure is higher in patients with restenosis than in those without restenosis. The purpose of this study was to evaluate prospectively whether the morphology of the ascending aortic pressure wave can be used to predict restenosis after PTCA. We measured the coronary artery diameter and the aortic pressure before PTCA. To quantify the relative magnitude of the pulsatile-to-mean aortic pressure, we normalized the pulse pressure to mean pressure and referred to this value as the fractional pulse pressure (PPf). We prospectively investigated the effect of PPf in relation to subsequent risk of restenosis after PTCA in patients with coronary artery disease. PPf was a powerful predictor of restenosis. Crude cumulative incidence rates of restenosis were 17.6% for the lowest, 33.3% for the middle, and 77. 8% for the highest tertile of PPf levels. After adjustments for age, smoking habits, systolic blood pressure, type 2 diabetes, hypercholesterolemia, old myocardial infarction, vessel location, vessel size, and sex, the odds ratio of restenosis was 33.5 (95% confidence interval, 2.04 to 550.6) for the highest tertile of the PPf level compared with the lowest tertile level. Pulsatility of the ascending aortic pressure is a predictive factor for restenosis after PTCA.

Relation of restenosis after excimer laser angioplasty to fasting insulin levels

Several studies have shown that diabetes mellitus increases the risk of restenosis after coronary intervention, but the role of insulin in restenosis has not been defined. The relation between fasting insulin levels and restenosis was evaluated prospectively at 6-month angiographic follow-up in 70 patients undergoing excimer laser coronary angioplasty of 75 lesions. Restenosis (>50% diameter narrowing on quantitative angiography) was observed at 37 of 75 treated sites (49%). Although patients with glucose intolerance and noninsulin-dependent diabetes mellitus showed a trend toward increased restenosis (restenosis rate 69%; odds ratio for restenosis 2.7 [95% confidence interval 0.76, 9.82]; p = 0.124), those with increased fasting insulin levels >15 μU/ml had reduced restenosis (restenosis rate 24%; odds ratio 0.22 [0.07, 0.67]; p = 0.008). Other factors including fasting serum glucose, glycated hemoglobin and lipoprotein fraction were not predictive of restenosis. The relation between insulin levels and restenosis after excimer laser angioplasty may provide insights into the biology of vascular injury and repair after coronary intervention.