From the Deutsches Herzzentrum and 1. Medizinische Klinik rechts der Isar
(A.K., A.S., S.E., H.S., J.D.); and Institut für Medizinische Statistik
und Epidemiologie (M.W.), Technische Universität München, Munich,
Germany.
Background—Little is known about the
behavior with regard to restenosis of multiple lesions within
the same patient treated with intracoronary stenting. Our
objective was to test the hypothesis that there is an intrapatient
dependence of restenosis between lesions.
Methods and Results—Quantitative analysis was carried out
on angiograms obtained before, immediately after, and at 6 months after
coronary stent placement in 1734 lesions in 1244 patients. We
used a specialized logistic regression that not only accounts for
intraclass correlation but also quantifies it in the form of odds ratio
(OR) as the change in risk of a lesion to develop restenosis if
another companion lesion had restenosis. The model was based on
23 patient- and lesion-related variables with binary
restenosis (diameter stenosis
Conclusions—This study demonstrates that there is a dependence of
restenosis between coronary lesions in patients who
undergo a multilesion intervention. The likelihood of
restenosis for a lesion is higher when another companion lesion
has also developed restenosis. Other, as yet unidentified
patient factors may be the source of this intrapatient correlation of
restenosis.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Interlesion Dependence of the Risk for Restenosis in Patients With Coronary Stent Placement in Multiple Lesions
50%) as end point. The
overall restenosis rate was 27.5%: 24.4% for single-lesion,
28.6% for double-lesion, and 33.8% for 3-lesion interventions.
After adjustment for the influence of significant factors
(hypercholesterolemia, systemic
arterial hypertension, diabetes mellitus, previous PTCA,
ostial lesion, location in left anterior descending coronary
artery, number of stents placed, vessel size, stenosis
severity, balloon-to-vessel ratio, and final result), the
analysis found a significant intrapatient correlation, OR 2.5
(1.8 to 3.6). This means that in patients with multilesion
interventions, the risk of a lesion to develop restenosis is
2.5 times higher if a companion lesion has restenosis,
independently of the presence or absence of analyzed patient
risk factors (eg, diabetes).
Key Words: stents • restenosis • lesion
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