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(Circulation. 2007;116:2802-2808.)
© 2007 American Heart Association, Inc.

Interventional Cardiology

Influence of a Pressure Gradient Distal to Implanted Bare-Metal Stent on In-Stent Restenosis After Percutaneous Coronary Intervention

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

From the Department of Cardiology, Odense University Hospital, Odense (L.O.J., P.T., H.S.H., A.J., K.N.H., K.E.P.); Department of Cardiology, Aarhus University Hospital, Skejby Sygehus, Aarhus (L.T., J.F.L., H.E.B., L.R.K.); and Department of Cardiology, Rigshospitalet, Copenhagen (H.K.), Denmark.

Correspondence to Lisette Okkels Jensen, MD, PhD, Department of Cardiology, Catheterization Laboratory, Odense University Hospital, Sdr Blvd 29, 5000 Odense C, Denmark. E-mail okkels{at}dadlnet.dk

Received March 20, 2007; accepted September 14, 2007.

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 (P_d=mean hyperemic coronary pressure and P_a=mean aortic pressure) were performed in the target vessel: (1) P_d/P_a as distal to the artery as possible (fractional flow reserve per definition); (2) P_d/P_a just distal to the stent; (3) P_d/P_a just proximal to the stent; and (4) P_d/P_a at the ostium. Residual abnormal P_d/P_a was defined as a pressure drop between P_d/P_a 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 P_d/P_a. Residual abnormal P_d/P_a (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 P_d/P_a distal to a bare-metal stent was an independent predictor of in-stent restenosis after implantation of a coronary bare-metal stent.

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