Predictors of Instent Restenosis after Successful Percutaneous Coronary Intervention for Total Coronary Occlusion

Background: Total coronary occlusion is still considered to be a challenge for the interventional cardiologist, it accounts for 30% of electively performed coronary angiographic procedures. The success rate for re-canalization of acute total occlusion is about 80%, in contrast to chronic total occlusion (CTO) which ranges from 42%-72% depending on duration of occlusion. The approach is compromised by compound restenosis and re-occlusion rate between 40-45%.Objective: To estimate the rate and predictors of restenosis in patients who were treated successfully by percutaneous intervention (PCI) using bare metal stents, after total occlusion of coronary vessels.Methods: This is a prospective unicenter study which included all patients with native total coronary artery occlusions who were scheduled for PCI in the cardiac catheterization laboratory, during the period of June 2002 till June 2004 and those with successful PCI were followed for six months.Results: The follow-up was done for eighty three patients (successful PCI), from which forty six patients were asymptomatic or had patent stent on angiographic follow-up and twelve patients were symptomatic and had angiographic evidence of instent restenosis or reocclusion. The clinical predictors of restenosis were diabetes mellitus (p 0.001) and dyslipidemia (p 0.001). The angiographic predictors of restenosis were chronic total occlusion (p 0.001) and the mean length of the lesion 10.9±4.6 (p=0.001). The procedural predictor of restenosis was minimal lumen diameter 2.4±0.9 and stent length 16 mm (p=0.001). Multivariate analysis was used to evaluate the predictors of restenosis in cases with total coronary artery occlusion and it showed that minimal lumen diameter 2.4±0.9 (p 0.001), was the most important independent predictor of restenosis in total coronary artery occlusion.Conclusion: The clinical predictors of restenosis were diabetes mellitus and dyslipidemia, while the angiographic predictors of restenosis were chronic total occlusion and the mean length of the lesion 10.9±4.6 (p=0.001). The minimal lumen diameter 2.4±0.9 was found to be the most important independent predictor of restenosis in total coronary artery occlusion.