Angiographic patterns of in-stent restenosis in men and women

BACKGROUND: The angiographic classification of in-stent restenosis (ISR) has been described. However, no comparative analysis of the morphologic ISR patterns between sexes has been performed. We sought to assess the ISR rate and the morphology of the different ISR patterns in the two genders. METHODS: The study population comprised 487 patients (231 male, 256 female) who underwent systematic angiographic follow-up 6 months after coronary stent implantation. RESULTS: The angiographic patterns of ISR were defined as: a) focal (length < or = 10 mm), b) diffuse (length > 10 mm and within the stent margins), c) proliferative (length > 10 mm extending beyond the stent margins), and d) totally occlusive. Angiographic ISR had a significantly higher incidence in women as compared to men (35.9 vs 29.4%, p = 0.04). In addition, angiographic analysis showed that, although all ISR patterns were present in both sexes, more males had focal ISR (59.7 vs 28.2%, p < 0.001). Conversely, females showed a higher incidence of diffuse ISR (71.8 vs 40.3%, p < 0.001), including intrastent, proliferative and occlusive patterns. The only predictors of a specific ISR pattern were diabetes mellitus and hypertension for diffuse ISR in both sexes. CONCLUSIONS: Females seem to be at higher risk of angiographic restenosis and higher levels of ISR class after coronary stent implantation. These findings may be prognostically important and should be considered for the appropriate use of newer revascularization strategies.