Interlesion dependence of the risk for restenosis in patients with coronary stent placement in in multiple lesions.
Interlesion dependence of the risk for restenosis in patients with coronary stent placement in in multiple lesions.
复制标题
多病灶置入冠状动脉支架的患者再狭窄风险的病灶间依赖性。
作者：
A. Kastrati;A. Schömig;S. Elezi;H. Schühlen;M. G. Wilhelm;J. Dirschinger
背景
对于同一患者接受冠状动脉内支架治疗的多个病变的再狭窄行为，我们知之甚少。我们的目的是验证这样的假设，即病变之间存在患者内部对再狭窄的依赖性。
方法和结果
对1244例患者1734个病变在支架置入前、术后即刻和术后6个月的冠状动脉造影结果进行了定量分析。我们使用了一种专门的Logistic回归，它不仅解释了组内相关性，而且还将其量化为优势比(OR)的形式，即如果一个伴随病变有再狭窄，则另一个病变发生再狭窄的风险的变化。该模型基于23个与患者和病变相关的变量，以二元再狭窄(直径狭窄>；或=50%)为终点。总的再狭窄率为27.5%，其中单支病变为24.4%，双支病变为28.6%，3支病变介入为33.8%。在调整了显著因素(高胆固醇血症、全身性高血压、糖尿病、既往PTCA、开口部病变、左前降支病变、支架置入数量、血管大小、狭窄程度、球囊/血管比和最终结果)的影响后，分析发现患者内相关性显著，OR2.5(1.8~3.6)。这意味着，在接受多支病变介入治疗的患者中，如果伴发病变有再狭窄，则病变发生再狭窄的风险是对照组的2.5倍，与分析的患者危险因素(如糖尿病)的存在与否无关。
结论
这项研究表明，在接受多支病变介入治疗的患者中，冠状动脉病变之间存在再狭窄的相关性。当另一个伴发病变也发生再狭窄时，该病变再狭窄的可能性更高。其他尚未确定的患者因素可能是这种患者内再狭窄相关性的来源。
BACKGROUND
Little is known about the behavior with regard to restenosis of multiple lesions within the same patient treated with intracoronary stenting. Our objective was to test the hypothesis that there is an intrapatient dependence of restenosis between lesions.
METHODS AND RESULTS
Quantitative analysis was carried out on angiograms obtained before, immediately after, and at 6 months after coronary stent placement in 1734 lesions in 1244 patients. We used a specialized logistic regression that not only accounts for intraclass correlation but also quantifies it in the form of odds ratio (OR) as the change in risk of a lesion to develop restenosis if another companion lesion had restenosis. The model was based on 23 patient- and lesion-related variables with binary restenosis (diameter stenosis > or =50%) as end point. The overall restenosis rate was 27.5%: 24.4% for single-lesion, 28.6% for double-lesion, and 33.8% for > or =3-lesion interventions. After adjustment for the influence of significant factors (hypercholesterolemia, systemic arterial hypertension, diabetes mellitus, previous PTCA, ostial lesion, location in left anterior descending coronary artery, number of stents placed, vessel size, stenosis severity, balloon-to-vessel ratio, and final result), the analysis found a significant intrapatient correlation, OR 2.5 (1.8 to 3.6). This means that in patients with multilesion interventions, the risk of a lesion to develop restenosis is 2.5 times higher if a companion lesion has restenosis, independently of the presence or absence of analyzed patient risk factors (eg, diabetes).
CONCLUSIONS
This study demonstrates that there is a dependence of restenosis between coronary lesions in patients who undergo a multilesion intervention. The likelihood of restenosis for a lesion is higher when another companion lesion has also developed restenosis. Other, as yet unidentified patient factors may be the source of this intrapatient correlation of restenosis.