Usefulness of predictors of angiographic restenosis to predict clinical restenosis after coronary stent placement

Introduction. After coronary stenting, several predictors of angiographic in-stent restenosis have been identified in different studies, howewer, little is known about predictors of clinical restenosis, a more functional aspect of coronary restenosis. Objective. To assess whether risk factors for angiographic restenosis previously described, are able to predict clinical reestenosis and at what rate in current practice. Patients and methods. 216 consecutive patients (271 stents in 256 lesions) with procedural success were followed-up for 17.6 +/- 10 months during periodic visits. Clinical restenosis was defined as the presence of symptoms or signs of myocardial ischemia, associated with greater than or equal to 50% diameter stenosis on the angiogram. Results. Clinical restenosis ocurred in 33 lesions (13%), which were revascularized with 34 stents associated with unstable angina in 29, acute myocardial infarction in three and death in one case. Multivariate analysis identified as independent predictors of clinical restenosis, a vessel diameter less than 3 mm (p < 0.001, OR 4.5), a restenotic lesion (p = 0.01, OR 2.9) and the presence of residual stenosis by visual stimate (>0%) after implantation (p = 0.02, OR 2.5), These three risk factors explained most clinical restenosis (73%), with rates of 22% when at least one was present and 4% in absence of all these. The presence of diabetes mellitus, the location in the anterior descending coronary artery or at coronary ostium, and the number or total length of stents per lesion did not achieve an independent, significant association as predictors of clinical restenosis. Conclusion. Most clinical restenosis after coronary stenting can be predicted by the restenotic character of the revascularized lesion, the diameter of the vessel being less than 3 mm and the presence of residual stenosis by visual stimate at the end of procedure.