Risk Factors For Non-stents Coronary Atherosclerotic Lesion Progression Or In-Stent Restenosis After Stent Implantation

Objective:To analysis the risk factors of non-stents coronary atherosclerotic lesion progression and in-stent restenosis after PCI.Methods:The study includes403patients who have underwent two or more than twice coronary angiography after6months or more months between January2005and January2009in General Hospital of PLA.We analyse the plaque on non-stents coronary vessels and stenting coronary vessels. The degree of stenosis and length of lesion were measured by QCA(Quantitative Coronary Angiography)which use the Dutch software QangioXA7.2. According to the results, patients are divided into lesion progression (stenosis rate of the second coronary angiogram increase20%when compared with the first)group and non progression group, stent restenosis group (Within stent, stent distal5mm and stent proximal5mm Lumen late loss rate>50%) and non restenosis group. Multivariate logistic regression analysis was used to identify predictors of nontarget coronary atherosclerotic lesion progression and in-stent restenosis after PCI.Results:l.A total of352patients includes551lesions.141(25.6%) lesions progression in subsequent repeat coronary angiography procedures, include54(9.8%) lesions underwent PCI.The mean rate of late lumen loss for lesion progression is29.61±15.82%.410(74.4%) lesions without progression, which including25(4.5%) lesions reversal. The mean rate of late lumen loss for non-progression group is1.26±4.40%. Multivariate logistic regression analysis revealed that progression of coronary atherosclerosis lesions correlated positively with luminal stenosis between40%-60%in the initial angiographic(OR=18.77,95%CI=1.63-216.04,P=0.02)、Multivessel disease(OR=3.06,95%CI=1.09-8.57,P=0.03)、Smoking (OR=2.77,95%CI=1.03-7.47,P=0.04)and the recheck interval time(OR=1.04,95%CI=1.02-1.06,P<0.01. A type lesions (<10mm)(OR=0.16,95%CI=0.05-0.55,P<0.01), Single-vessel disease(OR=0.08,95%CI=0.01-0.67,P=0.02)、reference diameter (OR=0.508,95%CI=0.203-1.25,P=0.06) was negatively correlated.2. A total of783stents were implanted in341patients,of which224(20.31%) stents restenosis including179(16.23%) stents revascularization during follow-up.The mean rate of late lumen loss for stent restenosis group is49.80±21.57%;579(73.9%) stents have no progression.,the mean rate of late lumen loss for non-progression group is2.16±5.66%.Multivariate logistic regression analysis revealed that stent stenosis correlated positively with C type lesions(OR=3.52,95%CI=1.22-10.10, P=0.02). stent implantation at LAD (OR=2.59,95%CI=1.23-5.44, P=0.01). stent implantation at LCX(OR=2.50,95%CI=1.04-6.01, P=0.04) Diabetes(OR=1.90,95%CI=1.09-3.28, P=0.02), Creatinine(OR=1.01,95%CI=1.00-1.02, P=0.04) and the recheck interval time(OR=1.02,95%CI=1.00-1.03,P=0.03).Conclusions:Stent restenosis and non-stents coronary atherosclerotic lesion progression occurs by different mechanisms, each influencing factors may also be different. The studies described above clearly that luminal stenosis between40%-60%in the initial angiographic、Multivessel disease、smoking、the recheck interval time are the risk factors of the lesion progression. C type lesions、stent implantation at LAD、stent implantation at LCX、Diabetes、Creatinine、the recheck interval time are the risk factors of restenosis after PCI. Risk factors should be controlled and prevention should be long-term emphasized and strengthened after PCI.