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Is coronary artery tortuosity a predisposing factor for drug-eluting stent restenosis?

Ist die Koronararterienschlängelung ein prädisponierender Faktor für die Restenose eines medikamentenfreisetzenden Stents?

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Abstract

Background

Coronary artery tortuosity (CAT) is a relatively common finding on coronary angiography and may be associated with impaired left ventricular relaxation and coronary ischemia However, the significance of CAT remains unknown. This study aimed to investigate whether the severity of tortuosity in the targeted coronary segment is a predictor of stent restenosis.

Methods

The study included a total of 637 patients undergoing drug-eluting stent implantation due to stable or unstable angina and who had no native coronary artery stenosis on their last coronary angiogram. The patients were separated into two groups: 312 patients with in-stent restenosis and 325 patients without in-stent restenosis. All patients underwent computed tomography (CT) coronary angiography after invasive angiography and CAT was calculated using the computer software.

Results

Patients with in-stent restenosis had higher CAT than those without restenosis (1.25 ± 0.11 vs. 1.11 + 0.07, p < 0.001). Multivariate Cox regression analysis showed that the tortuosity index (hazard ratio [HR]: 1.246 95% confidence interval [CI]: 1.127–1.376 p < 0.001) and the circumflex lesion (HR: 1.437 95% CI: 1.062–1.942 p = 0.019) were independently associated with in-stent restenosis. With the threshold value of severe tortuosity set at 1.15, the prediction of could be made with 81% sensitivity and 80% specificity.

Conclusion

The severity of tortuosity is proportional to coronary in-stent stenosis in patients with stable and unstable angina pectoris undergoing drug-eluting stent implantation for a severe single coronary artery.

Zusammenfassung

Hintergrund

Die Koronararterienschlängelung („coronary artery tortuosity“, CAT) ist ein relativ häufiger Befund in der Koronarangiographie und möglicherweise mit einer beeinträchtigten linksventrikulären Relaxation sowie Koronarischämie assoziiert. Die Bedeutung der CAT ist jedoch immer noch unbekannt. Ziel der vorliegenden Studie war es zu untersuchen, ob der Schweregrad der Schlängelung im koronaren Zielsegment einen Prädiktor für eine Stentrestenose darstellt.

Methoden

In die Studie wurden 637 Patienten einbezogen, bei denen die Implantation eines medikamentenfreisetzenden Stents wegen stabiler oder instabiler Angina pectoris erfolgte und die keine native Koronararterienstenose in ihrer letzten Koronarangiographie aufgewiesen hatten. Die Patienten wurden in 2 Gruppen eingeteilt: 312 Patienten mit Stentrestenose und 325 Patienten ohne Restenose innerhalb des Stents. Alle Patienten wurden mittels Computertomographie-Koronarangiographie nach invasiver Angiographie untersucht, und die CAT wurde mittels Computersoftware bestimmt.

Ergebnisse

Patienten mit Stentrestenose wiesen eine stärkere CAT auf als Patienten ohne Restenose (1,25 ± 0,11 vs. 1,11 + 0,07; p < 0,001). Die multivariate Cox-Regressionsanalyse ergab, dass der Schlängelungsindex (Hazard Ratio, HR: 1,246; 95%-Konfidenzintervall, 95%-KI: 1,127–1,376; p < 0,001) und eine Läsion der A. circumflexa (HR: 1,437; 95%-KI: 1,062–1,942; p = 0,019) unabhängig mit einer Stentrestenose assoziiert waren. Bei einem Schwellenwert für schwergradige Schlängelung von 1,15 konnte die Vorhersage mit einer Sensitivität von 81% und einer Spezifität von 80% getroffen werden.

Schlussfolgerung

Der Schweregrad der Schlängelung ist proportional zur Koronarstenose innerhalb des Stents bei Patienten mit stabiler und bei Patienten mit instabiler Angina pectoris, bei denen ein medikamentenfreisetzender Stent wegen einer schwer betroffenen einzelnen Koronararterie implantiert wurde.

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Authors and Affiliations

  1. Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey

    Fatih Levent MD

  2. Çiğli Regional Education Hospital, Bakırçay University, Izmir, Turkey

    Oktay Senoz MD & Zeynep Yapan Emren MD

  3. Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey

    Sadık Volkan Emren

  4. Manisa State Hospital, Manisa, Turkey

    Rahman Bilal Gediz MD

  5. Cumhuriyet Mah, Ozan Sok, Bina no. 10, 5. Kat, D. 9, Nilüfer, 16140, Bursa, Turkey

    Fatih Levent MD

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  1. Fatih Levent MD
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  2. Oktay Senoz MD
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  4. Zeynep Yapan Emren MD
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  5. Rahman Bilal Gediz MD
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Correspondence to Fatih Levent MD.

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F. Levent, O. Senoz, S. V. Emren, Z. Y. Emren, and R. B. Gediz declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Levent, F., Senoz, O., Emren, S.V. et al. Is coronary artery tortuosity a predisposing factor for drug-eluting stent restenosis?. Herz 47, 73–78 (2022). https://doi.org/10.1007/s00059-021-05036-z

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  • DOI: https://doi.org/10.1007/s00059-021-05036-z

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