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Jensen LO, Thayssen P, Thuesen L, Hansen HS, Lassen JF, Kelbaek H, Junker A, Hansen KN, Boetker HE, Krusell LR, Pedersen KE. Influence of a Pressure Gradient Distal to Implanted Bare-Metal Stent on In-Stent Restenosis After Percutaneous Coronary Intervention. Circulation 2007; 116:2802-8. [DOI: 10.1161/circulationaha.107.704064] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
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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Affiliation(s)
- Lisette Okkels Jensen
- 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
| | - Per Thayssen
- 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
| | - Leif Thuesen
- 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
| | - Henrik Steen Hansen
- 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
| | - Jens Flensted Lassen
- 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
| | - Henning Kelbaek
- 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
| | - Anders Junker
- 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
| | - Knud Noerregaard Hansen
- 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
| | - Hans Erik Boetker
- 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
| | - Lars Romer Krusell
- 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
| | - Knud Erik Pedersen
- 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
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