Clinical presentation and outcome of patients hospitalized for symptomatic in-stent restenosis treated by percutaneous coronary intervention: Comparison between drug-eluting stents and bate-metal stents

Axel De Labriolle, Laurent Bonello, Gilles Lemesle, Daniel H. Steinberg, Probal Roy, Zhenyi Xue, Kimberly Kaneshige, William O. Suddath, Loweli F. Satler, Kenneth M. Kent, Augusto D. Pichard, Joseph Lindsay, Ron Waksman*

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    21 Citations (Scopus)

    Abstract

    Background. - In-stent restenosis remains the major limitation of percutaneous coronary intervention (PCI), particularly after bare-metal stent (BMS) implantation. Drug-eluting stents (DES) decrease in-stent restenosis, which is thought to have minimal clinical consequences, but may increase the risk of stent thrombosis and its attendant high mortality rate. Aims. - To assess the clinical consequences of in-stent restenosis, including severity of associated illness and acute and 1-year outcomes and to compare DES and BMS in-stent restenosis. Methods. - Using our prospective PCI registry, we compared data from 1958 consecutive patients hospitalized with BMS in-stent restenosis between January 2000 and April 2003 and all 190 patients with DES in-stent restenosis admitted between April 2003 and September 2006. Risk-adjusted outcomes were calculated using propensity-score matching. Results. - An unstable presentation was noted in 78.1% of 2148 patients. Patients with DES in-stent restenosis presented more often with acute myocardial infarction (4.3% versus 1.6%, p < 0.001). At 1 year, mortality for all patients was 5.7% and target-vessel revascularization was 21.5%. After risk adjustment, target-vessel revascularization and target-vessel revascularization-major adverse cardiac events were greater in patients with DES in-stent restenosis (respectively, 27.8% versus 19.7%, p = 0.05; 32.5% versus 24.3%, p = 0.06). Conclusion. - In-stent restenosis is associated with unstable presentation and a higher 1 -year adverse events rate than expected in patients undergoing elective PCI. For an identical level of cardiac risk, it seems that DES in-stent restenosis outcomes are slightly worse than BMS in-stent restenosis outcomes.

    Original languageEnglish
    Pages (from-to)209-217
    Number of pages9
    JournalArchives of Cardiovascular Diseases
    Volume102
    Issue number3
    DOIs
    Publication statusPublished - Mar 2009

    Keywords

    • Bare-metal Stnt
    • Clinical resentation
    • Drug-eluting stent
    • In-stent restenosis
    • Outcome

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