Predictors of diffuse-type in-stent restenosis following drug-eluting stent implantation

Diffuse-type in-stent restenosis (ISR) is known to be associated with a higher rate of restenosis than focal-type ISR. Therefore, it is clinically important to identify the determinants of diffuse-type ISR following drug-eluting stent (DES) implantation. We investigated the clinical, procedural and angiographic variables for predicting diffuse-type ISR following DES implantation. A total of 173 ISR lesions in 159 patients (diffuse-type: 61 lesions, focal-type: 112 lesions) following DES implantation from February 2003 to May 2008 were included in this study. Clinical, procedural and quantitative coronary angiographic variables were analyzed to determine predictors of diffuse-type ISR following DES implantation. Univariate analysis showed that the absence of hypertension [odds ratio (OR), 0.493; 95% confidence interval (CI), 1.025-4.103, P=0.042], use of a paclitaxel-eluting stent (PES) (OR, 3.318; 95% CI, 1.730-6.365, P<0.001) and smaller post-stenting minimal luminal diameter (MLD; OR, 0.368, 95% CI, 0.168-0.808, P=0.013) were significantly associated with diffuse-type ISR. However, use of a PES (OR, 3.957; 95% CI, 1.977-7.922, P<0.001) and smaller post-stenting MLD (OR, 0.320; CI, 0.140-0.731, P=0.007) were only independent predictors of diffuse-type ISR by multivariate analysis. Diabetes was not a predictor of diffuse-type ISR. The use of a PES and the post-stenting MLD were related to diffuse-type ISR following DES implantation.