Journal
CIRCULATION-CARDIOVASCULAR INTERVENTIONS
Volume 3, Issue 4, Pages 327-334Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/CIRCINTERVENTIONS.110.946939
Keywords
restenosis; drug-eluting stents; percutaneous coronary intervention; risk assessment
Categories
Funding
- Volcano Corporation
- Terumo
- Amylin Pharmaceuticals
- Medicines Company
- Boston Scientific
- Schering Plough
- Cordis Corporation
- BMS-Sanofi
- Harvard Clinical Research Institute
- Abbott Vascular
- Medtronic Vascular
- Eli Lilly
- Daiichi Sankyo
- Bristol Myers Squibb
- Sanofi-Aventis
- Edwards Lifesciences
- MedRad
- Merck/Schering-Plough
- Eli Lilly-Daiichi Sankyo
- Millennium Pharmaceuticals
- Schering Plough Inc.
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Background-Prediction of restenosis after percutaneous coronary intervention (PCI) remains challenging, and existing risk assessment algorithms were developed before the widespread adoption of drug-eluting stents (DES). Methods and Results-We used data from the EVENT registry to develop a risk model for predicting target lesion revascularization (TLR) in 8829 unselected patients undergoing DES implantation between 2004 and 2007. Using a split-sample validation technique, predictors of TLR at 1 year were identified from two thirds of the subjects (derivation cohort) using multiple logistic regression. Integer point values were created for each predictor, and the summed risk score (range, 0 to 10) was applied to the remaining sample (validation cohort). At 1 year, TLR occurred in 4.2% of patients, and after excluding stent thrombosis and early mechanical complications, the incidence of late TLR (more likely representing restenosis-related TLR) was 3.6%. Predictors of TLR were age <60, prior PCI, unprotected left main PCI, saphenous vein graft PCI, minimum stent diameter <= 2.5 mm, and total stent length >= 40 mm. Comparison of observed versus predicted rates of TLR according to risk score demonstrated good model fit in the validation set. There was more than a 3-fold difference in TLR rates between the lowest risk category (score = 0; TLR rate, 2.2%) and the highest risk category (score >= 5; TLR rate, 7.5%). Conclusions-The overall incidence of TLR remains low among unselected patients receiving DES in routine clinical practice. A simple risk model incorporating 6 readily available clinical and angiographic variables helps identify individuals at extremely low (<2%) and modestly increased (>7%) risk of TLR after DES implantation. (Circ Cardiovasc Interv. 2010; 3: 327-334.)
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