Beschreibung:
<jats:p>
<jats:bold>
<jats:italic>Background—</jats:italic>
</jats:bold>
Fractional flow reserve predicts cardiac events after coronary stent implantation. The aim of the present study was to assess the 9-month angiographic in-stent restenosis rate in the setting of optimal stenting and a persisting gradient distal to the stent as assessed by a pressure wire pullback recording in the entire length of the artery.
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<jats:p>
<jats:bold>
<jats:italic>Methods and Results—</jats:italic>
</jats:bold>
In 98 patients with angina pectoris, 1 de novo coronary lesion was treated with a bare-metal stent. After stent implantation, pressure wire measurements (P
<jats:sub>d</jats:sub>
=mean hyperemic coronary pressure and P
<jats:sub>a</jats:sub>
=mean aortic pressure) were performed in the target vessel: (1) P
<jats:sub>d</jats:sub>
/P
<jats:sub>a</jats:sub>
as distal to the artery as possible (fractional flow reserve per definition); (2) P
<jats:sub>d</jats:sub>
/P
<jats:sub>a</jats:sub>
just distal to the stent; (3) P
<jats:sub>d</jats:sub>
/P
<jats:sub>a</jats:sub>
just proximal to the stent; and (4) P
<jats:sub>d</jats:sub>
/P
<jats:sub>a</jats:sub>
at the ostium. Residual abnormal P
<jats:sub>d</jats:sub>
/P
<jats:sub>a</jats:sub>
was defined as a pressure drop between P
<jats:sub>d</jats:sub>
/P
<jats:sub>a</jats:sub>
measured at points 1 and 2. Fractional flow reserve distal to the artery after stenting was significantly lower (0.88±0.21 versus 0.97±0.05;
<jats:italic>P</jats:italic>
<0.001), and angiographic in-stent binary restenosis rate was significantly higher (44.0% versus 8.1%;
<jats:italic>P</jats:italic>
<0.001) in vessels with a residual abnormal P
<jats:sub>d</jats:sub>
/P
<jats:sub>a</jats:sub>
. Residual abnormal P
<jats:sub>d</jats:sub>
/P
<jats:sub>a</jats:sub>
(odds ratio, 4.39; 95% confidence interval, 1.10 to 18.16;
<jats:italic>P</jats:italic>
=0.034), reference vessel size (odds ratio, 0.17; 95% confidence interval, 0.04 to 0.69;
<jats:italic>P</jats:italic>
=0.013), and stent length (odds ratio, 1.11; 95% confidence interval, 1.03 to 1.21;
<jats:italic>P</jats:italic>
=0.009) were predictors of angiographic in-stent restenosis after 9 months.
</jats:p>
<jats:p>
<jats:bold>
<jats:italic>Conclusions—</jats:italic>
</jats:bold>
A residual abnormal P
<jats:sub>d</jats:sub>
/P
<jats:sub>a</jats:sub>
distal to a bare-metal stent was an independent predictor of in-stent restenosis after implantation of a coronary bare-metal stent.
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