Coronary artery disease
Angiographic Patterns of Drug-Eluting Stent Restenosis and One-Year Outcomes After Treatment With Repeated Percutaneous Coronary Intervention

https://doi.org/10.1016/j.amjcard.2008.03.060Get rights and content

Patterns of in-stent restenosis (ISR) after drug-eluting stent (DES) implantation and outcomes after treatment have not been studied systematically in all comers. We compared patterns of ISR and outcomes of repeated percutaneous coronary intervention in consecutive patients with DES-ISR. A total of 137 patients with 182 lesions underwent repeated percutaneous coronary intervention for DES-ISR at Columbia University Medical Center from August 2004 to April 2006. DES-ISR was treated with repeated DES placement in 84% of patients and balloon angioplasty in 16%. There was 1 stent thrombosis at 30 days, and at 1 year, major adverse cardiac events occurred in 10% of patients, driven primarily by an 8% rate of target-lesion revascularization. After exclusion of 12 patients with multiple ISR lesions, data were further analyzed from 125 patients with 152 DES-ISR lesions, of which 118 were originally treated with sirolimus-eluting stents and 34 were treated with paclitaxel-eluting stents (PES-ISR). Baseline features were well matched between the 2 groups, except that patients with PES-ISR were older. A focal pattern of ISR was observed in 69.5% of patients overall. However, patients originally treated with a PES had a significantly higher frequency of diffuse-intrastent ISR in comparison with sirolimus-eluting stent ISR (30.3% vs 13.6%, p = 0.03). In conclusion, the pattern of ISR in most DES-ISR in this unselected patient population was focal, with higher rates of diffuse intrastent restenosis seen with PES-ISR. Treatment with either repeated DES implantation or balloon angioplasty for DES-ISR was safe and associated with low overall rates of target-lesion revascularization and major adverse cardiac events at 1 year.

Section snippets

Methods

Consecutive patients with DES-ISR who provided signed informed consent at Columbia University Medical Center, New York, New York, from August 2004 to April 2006 were entered in a dedicated database. No other specific exclusion criterion was applied.

The treatment modality of DES-ISR was chosen by individual operators, and all procedures, implantation devices, periprocedural anticoagulation, and antiplatelet therapy were prescribed per standard protocols. Patients were further stratified

Results

During the study period, 137 consecutive patients with 182 lesions underwent percutaneous coronary intervention for DES-ISR, but we excluded from the analysis 12 patients with multiple ISR lesions (total 30) treated with multiple stents. These patients presented a very high-risk profile at baseline, including diabetes (58%), renal insufficiency (25%), and previous coronary artery bypass grafting (58%). The predominant pattern of restenosis in this group of patients was focal (60%), mostly focal

Discussion

The main results of this study are that (1) treatment of DES failure with repeated percutaneous coronary intervention (DES or balloon angioplasty) was safe and effective up to 1 year, and (2) patterns of DES-ISR in our population were predominantly focal, but with a higher proportion of diffuse-intrastent ISR in patients with PES-ISR in comparison to SES-ISR. However, treatment of both types of DES-ISR was associated with good outcomes.

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