Moscucci M, Piana R N, Kuntz R E, Kugelmass A D, Carrozza J P, Senerchia C, Baim D S
Charles A. Dana Research Institute, Beth Israel Hospital, Boston, Massachusetts 02215.
Am J Cardiol. 1994 Jun 15;73(16):1147-53. doi: 10.1016/0002-9149(94)90172-4.
Lesions that have developed restenosis after a prior intervention may be more likely to develop restenosis after subsequent percutaneous interventions. To determine if this is an independent effect, the clinical characteristics and immediate angiographic outcomes of 179 prior restenosis lesions were compared with those of 254 primary lesions after stenting or directional atherectomy. Six-month angiographic follow-up was obtained for 79% of successfully treated lesions. Univariable and multivariable logistic regression was used to determine how binary restenosis (defined as > or = 50% diameter stenosis at follow-up) was influenced by postprocedure luminal diameter, left anterior descending artery location, diabetes mellitus, as well as prior restenosis. At 6-month follow-up, prior restenosis lesions had a significantly smaller late diameter (1.77 vs 2.18 mm, p < 0.001), more absolute late loss (1.35 vs 1.14 mm, p = 0.051), a higher loss index (0.58 vs 0.45, p < 0.02), and a higher binary restenosis rate (37.3% vs 24.4%, p = 0.01). Whereas univariable analysis revealed that left anterior descending artery location, diabetes mellitus, postprocedure luminal diameter < 3.1 mm, and prior restenosis were each strong predictors of binary restenosis (all p < 0.02), multivariable analysis showed that after adjustment for left anterior descending artery location, diabetes, and postprocedure luminal diameter, prior restenosis was no longer an independent predictor of restenosis (odds ratio 1.57, 95% confidence interval 0.95-2.60, p = 0.073). In conclusion, although prior restenosis lesions do show more restenosis than primary lesions, much of this effect is due to preselection of a population enriched in other known factors that predispose to restenosis.
在先前的介入治疗后发生再狭窄的病变，在后续经皮介入治疗后更有可能发生再狭窄。为了确定这是否是一种独立的效应，将179个先前再狭窄病变的临床特征和即刻血管造影结果与254个支架置入或定向旋切术后的原发病变进行了比较。79%成功治疗的病变获得了6个月的血管造影随访。采用单变量和多变量逻辑回归来确定二元再狭窄（定义为随访时直径狭窄≥50%）如何受到术后管腔直径、左前降支动脉位置、糖尿病以及先前再狭窄的影响。在6个月随访时，先前再狭窄病变的晚期直径明显更小（1.77对2.18 mm，p<0.001），绝对晚期丢失更多（1.35对1.14 mm，p=0.051），丢失指数更高（0.58对0.45，p<0.02），二元再狭窄率更高（37.3%对24.4%，p=0.01）。单变量分析显示，左前降支动脉位置、糖尿病、术后管腔直径<3.1 mm以及先前再狭窄均是二元再狭窄的有力预测因素（均p<0.02），而多变量分析表明，在调整左前降支动脉位置、糖尿病和术后管腔直径后，先前再狭窄不再是再狭窄的独立预测因素（比值比1.57，95%置信区间0.95 - 2.60，p=0.073）。总之，虽然先前再狭窄病变确实比原发病变表现出更多的再狭窄，但这种效应很大程度上是由于预先选择了富含其他已知易导致再狭窄因素的人群。
