Lee S G, Lee C W, Hong M K, Park H K, Kim J J, Park S W, Park S J
Department of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea.
Catheter Cardiovasc Interv. 1999 Aug;47(4):406-9; discussion 410. doi: 10.1002/(SICI)1522-726X(199908)47:4<406::AID-CCD5>3.0.CO;2-P.
Diffuse-type in-stent restenosis (ISR) is associated with higher rate of restenosis after balloon angioplasty, requiring new therapeutic modalities; therefore, it is clinically important to identify the determinants of diffuse-type ISR. We evaluate the clinical and angiographic variables to predict diffuse-type ISR after coronary stent placement. Two hundred and ten ISR lesions in 196 patients (diffuse ISR, 114 lesions; focal ISR, 96 lesions) were reviewed in this study. Clinical, procedural and quantitative coronary angiographic parameters were analyzed. Diffuse-type ISR was defined as a > or = 50% lumen narrowing and > or = 10-mm length. Univariate analysis revealed that initial lesion length, smaller vessel size, diabetes, multivessel disease, multiple stents, and long stent were significantly associated with diffuse-type ISR. However, diabetes was the only independent predictor of diffuse-type ISR by stepwise multiple regression analysis (OR, 3.3; 95% CI, 1.4-7.4, P = 0.001). Diabetes was associated with diffuse-type ISR after coronary stent placement. It may reflect enhanced rate of neointimal hyperplasia within the stent in diabetic patients.
弥漫型支架内再狭窄（ISR）与球囊血管成形术后较高的再狭窄率相关，需要新的治疗方式；因此，识别弥漫型ISR的决定因素具有临床重要性。我们评估临床和血管造影变量以预测冠状动脉支架置入术后的弥漫型ISR。本研究回顾了196例患者中的210处ISR病变（弥漫型ISR，114处病变；局灶型ISR，96处病变）。分析了临床、手术和定量冠状动脉造影参数。弥漫型ISR定义为管腔狭窄≥50%且长度≥10 mm。单因素分析显示，初始病变长度、较小的血管尺寸、糖尿病、多支血管病变、多个支架和长支架与弥漫型ISR显著相关。然而，通过逐步多元回归分析，糖尿病是弥漫型ISR的唯一独立预测因素（OR，3.3；95% CI，1.4 - 7.4，P = 0.001）。糖尿病与冠状动脉支架置入术后的弥漫型ISR相关。这可能反映了糖尿病患者支架内新生内膜增生率增加。
