Impact of Pre-Stent Implantation Plaque Burden on the Development of Stent Restenosis

Abstract

Aim: In this study we have used quantitative coronary angiography (QCA) and the Image J program in order to investigate the influence of plaque area, as identified prior to stent implantation, on the development of stent restenosis. Material and Method: 5180 coronary angiography procedures were performed between March 2008 and July 2011. Of these, 227 presented with in-stent restenosis. After application of the exclusion criteria, 164 intracoronary stents implanted in 121 patients were retrospectively investigated. These stents were divided into two groups depending upon the clinical status of the patient: (a) those who developed in-stent restenosis (n: 77, 47%), and (b) those who failed to develop in-stent restenosis (n: 87, 53%). Narrowing by 50% or more, as identified during coronary angiography performed at least six months after the stent implantation, was considered as positive for development of in-stent restenosis. Plaque area measurement in the patients was performed using quantitative coronary angiography (QCA) and the Image J program. Results: Plaque area measurement when performed quantitatively revealed no statistically significant difference between the groups (p>0.05). However, significant difference in area was observed when Image J was used (p<0.05). Statistically significant differences were observed between groups in terms of history of hypertension and hyperlipidemia, use of statins, HDL values, and lesion type (p<0.05); the difference in terms of presence of diabetes or smoking status (p>0.05) was not significant. There was a relationship among the development of restenosis and hypertension, non-usage of statin therapy, HDL level, poor lesion type, and plaque area as measured with Image J. Discussion: Hypertension, non-usage statin therapy, low levels of HDL, poor lesion type, and larger plaque areas as measured with the Image J program were identified as important indicators for development of in-stent restenosis.