Significant Association of Coronary Artery Calcification in Stent Delivery Route With Restenosis After Sirolimus-Eluting Stent Implantation

Background: Sirolimus-eluting stent (SES) has revolutionized interventional cardiology. Its application is spreading to complex, high-risk Subsets of patients and lesions. Therefore, it is important to determine the factors associated with post-SES restenosis. Methods and Results: The study investigated 341 patients with angina pectoris, in whom SES was implanted. The coronary artery calcification (CAC) degree was assessed using the angiographic scoring system as follows: 0, none; 1, blocky or spotty calcification; 2, linear calcification compromising I side of the arterial lumen; 3, linear calcification found unidirectionally compromising both sides of the arterial lumen; 4, linear calcification found bidirectionally compromising both sides of the arterial lumen; and 5. blanket/circumferential and dense calcification. Restenosis was observed in 23 patients (7.3%). The target lesion (1.8 +/- 1.7 vs 0.7 +/- 1.1 [mean +/- SD]) and stent delivery route CAC scores (3.1 +/- 2.5 vs 1.4 +/- 2.0) were significantly higher in patients with restenosis than in those without it (P<0.0001). In multivariate analysis, the CAC score of the stent delivery route was independently associated with restenosis (odds ratio of 6.804, P<0.05), although CAC score of the target lesion was not. Conclusions: CAC in the stent delivery route is an important determinant of post-SES restenosis. (Circ J 2009; 73: 1856-1863)