Skip to main content
Journal cover image

Combining clinical and angiographic variables for estimating risk of target lesion revascularization after drug eluting stent placement.

Publication ,  Journal Article
Stolker, JM; Cohen, DJ; Kennedy, KF; Pencina, MJ; Arnold, SV; Kleiman, NS; Spertus, JA; EVENT Investigators,
Published in: Cardiovasc Revasc Med
2017

BACKGROUND: Drug-eluting stents (DES) reduce restenosis but require prolonged antiplatelet therapy, when compared with bare metal stents. Ideally, the patient should be involved in this risk:benefit assessment prior to selecting DES, to maximize the benefits and cost-effectiveness of care, and to improve medication adherence. However, accurate estimation of restenosis risk may require angiographic factors identified at cardiac catheterization. METHODS: In a large PCI registry, we used logistic regression to identify clinical and angiographic predictors of clinically-driven target lesion revascularization (TLR) over the first year after stent placement. Discrimination c-statistic and integrated discrimination improvement (IDI) were used to calculate the incremental utility of angiographic variables when added to clinical predictors. RESULTS: Of 8501 PCI patients, TLR occurred in 4.5%. After adjusting for DES use, clinical TLR predictors were younger age, female sex, diabetes, prior PCI, and prior bypass surgery (model c-statistic 0.630). Angiographic predictors were vein graft PCI, in-stent restenosis lesion, longer stent length, and smaller stent diameter (c-statistic 0.650). After adding angiographic factors to the clinical model, c-statistic improved to 0.680 and the average separation in TLR risk among patients with and without TLR improved by 1% (IDI=0.010, 95% CI 0.009-0.014), primarily driven by those experiencing TLR (from 5.9% to 6.9% absolute risk). CONCLUSIONS: Among unselected PCI patients, the incidence of clinically-indicated TLR is <5% at 1-year, and standard clinical variables only moderately discriminate who will and will not experience TLR. Angiographic variables significantly improve TLR risk assessment, suggesting that stent selection may be best performed after coronary anatomy has been delineated. SHORT SUMMARY (FOR ANNOTATED TABLE OF CONTENTS): Although several recent studies have challenged traditional expectations regarding the duration of dual antiplatelet therapy, current guidelines recommend at least 6 to 12months of treatment after implantation of a drug eluting stent, with a shorter course for bare metal stents. Stent selection ideally should involve input from the patient receiving these stents, but multiple studies have suggested that angiographic factors - obtained after the patient has received sedation during the diagnostic catheterization - are important predictors of repeat revascularization. In this analysis from a large registry of patients receiving coronary stents, angiographic characteristics were found to significantly improve risk assessment for target lesion revascularization, when added to clinical variables alone.

Duke Scholars

Published In

Cardiovasc Revasc Med

DOI

EISSN

1878-0938

Publication Date

2017

Volume

18

Issue

3

Start / End Page

169 / 176

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Registries
  • Prosthesis Design
  • Predictive Value of Tests
  • Percutaneous Coronary Intervention
  • Middle Aged
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Stolker, J. M., Cohen, D. J., Kennedy, K. F., Pencina, M. J., Arnold, S. V., Kleiman, N. S., … EVENT Investigators, . (2017). Combining clinical and angiographic variables for estimating risk of target lesion revascularization after drug eluting stent placement. Cardiovasc Revasc Med, 18(3), 169–176. https://doi.org/10.1016/j.carrev.2016.12.014
Stolker, Joshua M., David J. Cohen, Kevin F. Kennedy, Michael J. Pencina, Suzanne V. Arnold, Neal S. Kleiman, John A. Spertus, and John A. EVENT Investigators. “Combining clinical and angiographic variables for estimating risk of target lesion revascularization after drug eluting stent placement.Cardiovasc Revasc Med 18, no. 3 (2017): 169–76. https://doi.org/10.1016/j.carrev.2016.12.014.
Stolker JM, Cohen DJ, Kennedy KF, Pencina MJ, Arnold SV, Kleiman NS, et al. Combining clinical and angiographic variables for estimating risk of target lesion revascularization after drug eluting stent placement. Cardiovasc Revasc Med. 2017;18(3):169–76.
Stolker, Joshua M., et al. “Combining clinical and angiographic variables for estimating risk of target lesion revascularization after drug eluting stent placement.Cardiovasc Revasc Med, vol. 18, no. 3, 2017, pp. 169–76. Pubmed, doi:10.1016/j.carrev.2016.12.014.
Stolker JM, Cohen DJ, Kennedy KF, Pencina MJ, Arnold SV, Kleiman NS, Spertus JA, EVENT Investigators. Combining clinical and angiographic variables for estimating risk of target lesion revascularization after drug eluting stent placement. Cardiovasc Revasc Med. 2017;18(3):169–176.
Journal cover image

Published In

Cardiovasc Revasc Med

DOI

EISSN

1878-0938

Publication Date

2017

Volume

18

Issue

3

Start / End Page

169 / 176

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Registries
  • Prosthesis Design
  • Predictive Value of Tests
  • Percutaneous Coronary Intervention
  • Middle Aged