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The relation between the angiographic severity of a coronary lesion and its functional significance has been studied extensively for native coronary lesions.1 Diameter stenosis, lesion length, lesion eccentricity, and lesion complexity have been found in both in vitro and in vivo studies to determine the haemodynamic relevance of a coronary lesion.2,3 In a recent meta-analysis, nearly 60% of patients with a > 50% diameter stenosis in a restenotic stent were found to be asymptomatic.4 Stent restenosis differs from native coronary lesions in its morphology, histology, and geometry.5 Usually the stent structure, which is either round or oval, is covered by a relatively smooth neointimal layer. Thus, in contrast to native coronary lesions, which may have an eccentric and complex cross sectional geometry, the lumen of a stent restenosis is thought to have a more homogenous and less complex geometry. Therefore, the lesion severity threshold for limiting coronary flow reserve may be higher in stent restenoses than in native lesions. To test this hypothesis, we performed a direct comparison between stent and native lesions regarding their haemodynamic relevance.
METHODS
Patients were identified from our angiography and myocardial perfusion imaging databases by a computerised search. They included 14 399 coronary angiographies in the angiographic database and 4644 stress perfusion studies in the myocardial perfusion imaging database, collected between 1998–2001. Patients had to have undergone myocardial perfusion imaging within two months of coronary angiography to determine the haemodynamic impact of a single coronary lesion assessed as potentially flow limiting by angiography. …