Clinical presentation and outcomes of coronary in-stent restenosis across 3-stent generations

Marco A. Magalhaes, Sa'ar Minha, Fang Chen, Rebecca Torguson, Al Fazir Omar, Joshua P. Loh, Ricardo O. Escarcega, Michael J. Lipinski, Nevin C. Baker, Hironori Kitabata, Hideaki Ota, William O. Suddath, Lowell F. Satler, Augusto D. Pichard, Ron Waksman

研究成果: Article査読

30 被引用数 (Scopus)

抄録

Background-Clinical presentation of bare metal stent in-stent restenosis (ISR) in patients undergoing target lesion revascularization is well characterized and negatively affects on outcomes, whereas the presentation and outcomes of first- and second-generation drug-eluting stents (DESs) remains under-reported. Methods and Results-The study included 909 patients (1077 ISR lesions) distributed as follows: bare metal stent (n=388), first-generation DES (n=425), and second-generation DES (n=96), categorized into acute coronary syndrome (ACS) or non-ACS presentation mode at the time of first target lesion revascularization. ACS was further classified as myocardial infarction (MI) and unstable angina. For bare metal stent, first-generation DES and second-generation DES, ACS was the clinical presentation in 67.8%, 71.0%, and 66.7% of patients, respectively (P=0.470), whereas MI occurred in 10.6%, 10.1%, and 5.2% of patients, respectively (P=0.273). The correlates for MI as ISR presentation were current smokers (odds ratio, 3.02; 95% confidence interval [CI], 1.78-5.13; P<0.001), and chronic renal failure (odds ratio, 2.73; 95% CI, 1.60-4.70; P<0.001), with a protective trend for the second-generation DES ISR (odds ratio, 0.35; 95% CI, 0.12-1.03; P=0.060). ACS presentations had an independent effect on major adverse cardiac events (death, MI, and re-target lesion revascularization) at 6 months (MI versus non-ACS: adjusted hazard ratio, 4.06; 95% CI, 1.84-8.94; P<0.001; unstable angina versus non-ACS: adjusted hazard ratio, 1.98; 95% CI, 1.01-3.87; P=0.046). Conclusions-ISR clinical presentation is similar irrespective of stent type. MI as ISR presentation seems to be associated with patient and not device-related factors. ACS as ISR presentation has an independent effect on major adverse cardiac events, suggesting that ISR remains a hazard and should be minimized.

本文言語English
ページ(範囲)768-776
ページ数9
ジャーナルCirculation: Cardiovascular Interventions
7
6
DOI
出版ステータスPublished - 01-12-2014
外部発表はい

All Science Journal Classification (ASJC) codes

  • 循環器および心血管医学

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