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School of Internal
Medicine, Department of Cardiology, Pneumology and Angiology,
Heinrich-Heine-University, Moorenstrasse 5, D-40225 Düsseldorf,
Germany
Correspondence to: Dr Heidland heidland{at}med.uni-duesseldorf.de
Accepted 5 November
2000
OBJECTIVE
To analyse the variables involved in the high
restenosis rate following stent implantation in coronary artery bypass grafts.
DESIGNA retrospective analysis of a consecutive group of
patients attending a tertiary centre.
PATIENTSThe long term angiographic outcome of 219 stent
implantations for individual lesions performed in 191 patients was
investigated. Multivariate analysis correlated clinical, procedural,
and angiographic variables with the incidence of angiographic
restenosis, defined as diameter stenosis > 50% at follow up.
RESULTSAngiographic restenosis was observed in 34% of
lesions treated. Multiple logistic regression analysis defined diabetes
mellitus (odds ratio 6.91, 95% confidence interval (CI) 2.43 to 9.69), graft recanalisation (2.89, 95% CI 1.18 to 6.63), lesion at the aortic
anastomosis (6.98, 95% CI 2.77 to 21.31), lesion at the coronary
anastomosis (3.01, 95% CI 1.19 to 7.69), high diameter stenosis after
stent placement (7.21, 95% CI 2.66 to 16.81), placement of long stents
(2.73, 95% CI 1.09 to 7.39), and implantation of more than one stent
(7.31, 95% CI 2.08 to 19.96) as independent predictors of graft
in-stent restenosis.
CONCLUSIONSThere appears to be a specific risk factor
constellation contributing to the high restenosis rate following stent
implantation in venous bypass grafts. Critical consideration of these
variables may help identify patients who are poor candidates for stent
implantation and who may benefit from a different approach.
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