Effect of statin therapy on restenosis after coronary stent implantation

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Abstract

The effect of statins on the development of restenosis and clinical outcome after coronary stent implantation was assessed in a retrospective analysis of 525 consecutive patients. Baseline clinical, angiographic, and procedural characteristics did not differ between 258 patients with and 267 patients without statin therapy. Statin therapy was associated with a significantly (p <0.04) improved survival free of myocardial infarction and a significant reduction in repeat target vessel revascularization procedures (27.9% vs 36.7%, p <0.05) during 6-month follow-up. Minimal lumen diameter was significantly larger (1.98 ± 0.88 vs 1.78 ± 0.88 mm, p = 0.01), late lumen loss was significantly less (0.64 ± 0.8 vs 0.8 ± 0.8 mm, p = 0.032), and net gain significantly increased (1.2 ± 0.88 vs 0.98 ± 0.92 mm, p = 0.009) in patients receiving statin therapy. Dichotomous angiographic restenosis (≥50%) rates were significantly lower, with 25.4% in the statin group compared with 38% in the no-statin group (p <0.005). Multivariate analysis identified statin therapy (p = 0.005), minimal lumen diameter immediately after stenting (p = 0.02), and stent length (p = 0.02) as independent predictors for subsequent restenosis development. Thus, statin therapy is associated with reduced recurrence rates and improved clinical outcome after coronary stent implantation.

Section snippets

Study population

The study population consisted of 525 consecutive patients undergoing coronary stent implantation from January 1996 through March 1998. Indications for stenting were coronary dissection after percutaneous transluminal coronary angioplasty, suboptimal results (≥30% residual stenosis) after percutaneous transluminal coronary angioplasty, lesions in venous bypass grafts, and restenotic lesions. All patients with a stent successfully inserted in the target lesion were included in the analysis

Baseline characteristics

Baseline clinical and procedural characteristics of the study population are summarized in TABLE I, TABLE II. There were essentially no differences between both groups with respect to any clinical or procedural variable. In addition, the type of stents used did not differ between both goups. Baseline total cholesterol and low-density lipoprotein (LDL) levels were significantly higher in patients in whom statin therapy was initiated. Most patients (176, 68.2%) received simvastatin, 36 (14.3%)

Discussion

The results of the present study demonstrate for the first time that statin therapy is associated with a significant reduction in restenosis development after coronary stent implantation. Importantly, the reduced restenosis rate associated with statin therapy is accompanied by an improved survival free of myocardial infarction after coronary stent implantation. These findings extend the well-established clinical benefit of statin therapy to reduce morbidity and mortality from coronary heart

Acknowledgements

We gratefully acknowledge Beate Jung and Sonja Götte for expert technical assistance.

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