Defining coronary restenosis. Newer clinical and angiographic paradigms.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Coronary artery disease requiring drug-eluting stent implantation (n=141). Intervention: Pre-procedural brachial-ankle pulse wave velocity (baPWV). Primary outcome: Late lumen loss after drug-eluting stent implantation (β = -0.021 mm per 1 SD, 95% CI -0.091 to 0.050, p=0.57).

Richard E. Kuntz; Donald S. Baim

doi:10.1161/01.cir.88.3.1310

September 1, 1993Circulation

Defining coronary restenosis. Newer clinical and angiographic paradigms.

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Key result

Pre-procedural brachial-ankle pulse wave velocity was not independently associated with acute gain or late lumen loss after drug-eluting stent implantation following adjustment for clinical and angiographic confounders.

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Why the study?

Does higher pre-procedural brachial-ankle pulse wave velocity (baPWV) independently predict lower acute gain or greater late lumen loss in patients undergoing DES implantation?

Key Points

To determine whether systemic arterial stiffness, measured by brachial-ankle pulse wave velocity, independently influences acute gain and late lumen loss after drug-eluting stent implantation.
Retrospective single-center cohort study of 242 lesions across 141 patients (mean age 66.0 ± 10.3 years, 66.7% male) undergoing drug-eluting stent implantation with quantitative coronary angiography.
Assessed pre-procedural brachial-ankle pulse wave velocity (baPWV) against angiographic acute gain (n=242) and late lumen loss (n=240) over a median follow-up of 280 days (IQR 273 to 306).
Applied fixed pre-specified multivariable regression models adjusting for age, sex, diabetes, hypertension, smoking, renal function, follow-up duration, and reference-vessel diameter.
Unadjusted baPWV was weakly inversely correlated with acute gain (r = −0.169, 95% CI −0.289 to −0.044, p = 0.008; crude β = −0.093 mm per 1 SD, p = 0.013) but was uncorrelated with late lumen loss (r = −0.011, 95% CI −0.14 to +0.12, p = 0.86).
After adjustment for cardiometabolic covariates, baPWV showed no independent association with acute gain (fully adjusted β = −0.019 mm per 1 SD, 95% CI −0.106 to +0.068, p = 0.67) or late lumen loss (fully adjusted β = −0.021 mm per 1 SD, 95% CI −0.091 to +0.050, p = 0.57).

Study Design

Type

Cohort (n=141)

Blinding

Single-blind

Multicenter

No

Structured PICO

Does higher pre-procedural brachial-ankle pulse wave velocity (baPWV) independently predict lower acute gain or greater late lumen loss in patients undergoing DES implantation?

P

Population

141 patients (242 lesions) with coronary artery disease undergoing drug-eluting stent implantation who had pre-procedural arterial stiffness measurements and paired follow-up quantitative coronary angiography at a median of 280 days.

E

Exposure

Measurement of pre-procedural brachial-ankle pulse wave velocity (baPWV) evaluated as a continuous independent variable (per 1 SD increment).

O

Outcome

Co-primary endpoints: Acute gain (immediate post-PCI minus pre-PCI minimum lumen diameter) and late lumen loss (immediate post-PCI minus follow-up minimum lumen diameter at median 280 days).surrogate

Main Result

Mean Difference: -0.021 (95% CI -0.091–0.05)

p-value: p=0.57

Limitations

Retrospective, single-center design limits causal inference and external generalizability.
Study population was defined by the performance of follow-up QCA, introducing selection bias.
Arterial stiffness was measured only once pre-procedurally and is blood-pressure dependent, allowing potential residual confounding.
Lack of data on lesion calcification and post-dilation which modify stent expansion independently of arterial stiffness.
Lack of intravascular imaging (IVUS/OCT) limits the ability to assess the coronary substrate, plaque composition, and true vessel size.
Retrospective, single-center design precludes causal inference and limits generalizability.
Study population was defined by the performance of follow-up QCA, creating selection bias as routine surveillance is no longer standard practice.
baPWV was measured only once and is blood-pressure dependent, allowing potential residual confounding.
Lack of intravascular imaging (IVUS/OCT) or data on lesion calcification and post-dilation which influence stent expansion.

Implication

Pre-procedural baPWV does not independently predict local angiographic acute gain or late lumen loss after DES implantation, indicating its established prognostic value relates to systemic patient-level risk rather than focal lesion-level stent response.

Abstract

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Discussion

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Cite This Study

Kuntz et al. (1993) conducted a cohort in Coronary artery disease requiring drug-eluting stent implantation (n=141). Pre-procedural brachial-ankle pulse wave velocity (baPWV) was evaluated on Late lumen loss after drug-eluting stent implantation (β = -0.021 mm per 1 SD, 95% CI -0.091 to 0.050, p=0.57). Pre-procedural brachial-ankle pulse wave velocity was not independently associated with acute gain or late lumen loss after drug-eluting stent implantation following adjustment for clinical and angiographic confounders.

synapsesocial.com/papers/6ad0ee214d8518257913c0cc https://doi.org/10.1161/01.cir.88.3.1310

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Defining coronary restenosis. Newer clinical and angiographic paradigms.

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Defining coronary restenosis. Newer clinical and angiographic paradigms.

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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