Intravascular ultrasound predictors of angiographic restenosis in lesions treated with Palmaz-Schatz stents.

OBJECTIVES This study sought to evaluate the clinical, procedural, preinterventional and postinterventional quantitative coronary angiographic (QCA) and intravascular ultrasound (IVUS) predictors of restenosis after Palmaz-Schatz stent placement. BACKGROUND Although Palmaz-Schatz stent placement reduces restenosis compared with balloon angioplasty, in-stent restenosis remains a major clinical problem. METHODS QCA and IVUS studies were performed before and after intervention (after stent placement and high pressure adjunct balloon angioplasty) in 382 lesions in 291 patients treated with 476 Palmaz-Schatz stents for whom follow-up QCA data were available 5.5 +/- 4.8 months (mean +/- SD) later. Univariate and multivariate predictors of QCA restenosis (> or = 50% diameter stenosis at follow-up, follow-up percent diameter stenosis [DS] and follow-up minimal lumen diameter [MLD]) were determined. RESULTS Three variables were the most consistent predictors of the follow-up angiographic findings: ostial lesion location, IVUS preinterventional lesion site plaque burden (plaque/total arterial area) and IVUS assessment of final lumen dimensions (whether final lumen area or final MLD). All three variables predicted both the primary (binary restenosis) and secondary (follow-up MLD and follow-up DS) end points. In addition, a number of variables predicted one or more but not all the end points: 1) restenosis (IVUS preinterventional lumen and arterial area); 2) follow-up DS (QCA lesion length); and 3) follow-up MLD (QCA lesion length and preinterventional MLD and DS and IVUS preinterventional lumen and arterial area). CONCLUSIONS Ostial lesion location and IVUS preinterventional plaque burden and postinterventional lumen dimensions were the most consistent predictors of angiographic in-stent restenosis.