In-Stent Restenosis of Drug-Eluting Stents Compared With a Matched Group of Patients With De Novo Coronary Artery Stenosis.

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Citation: American Journal of Cardiology. 121(12):1512-1518, 2018 06 15.PMID: 29627111Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Angina, Unstable/ep [Epidemiology] | *Coronary Restenosis/ep [Epidemiology] | *Coronary Stenosis/ep [Epidemiology] | *Drug-Eluting Stents | *Mortality | *Myocardial Infarction/ep [Epidemiology] | *Myocardial Revascularization/sn [Statistics & Numerical Data] | Acute Coronary Syndrome/ep [Epidemiology] | Aged | Cardiovascular Diseases/mo [Mortality] | Coronary Restenosis/pp [Physiopathology] | Coronary Stenosis/pp [Physiopathology] | Coronary Stenosis/su [Surgery] | Female | Humans | Male | Middle Aged | Neointima | Percutaneous Coronary Intervention | Proportional Hazards Models | Retrospective StudiesYear: 2018Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0002-9149
Name of journal: The American journal of cardiologyAbstract: Copyright (c) 2018 Elsevier Inc. All rights reserved.Drug-eluting stents (DES) significantly reduced the incidence of in-stent restenosis (ISR). However, ISR still exists in the contemporary DES era. Previously deemed to be a benign process, ISR leads to complex presentation and intervention. This study aimed to compare the presentation and outcome of DES-ISR versus de novo lesions. We performed a retrospective analysis of 11,666 patients receiving percutaneous coronary intervention from 2003 to 2017 and divided them into 2 groups by de novo stenosis and ISR. They were matched based on common cardiovascular risk factors at a 4:1 ratio, respectively. After matching, a total of 1,888 patients with 3,126 de novo lesions and 472 patients with 508 ISR lesions were analyzed. Patients with ISR presented more often with unstable angina (61% vs 45%, p<0.001) and less often with myocardial infarction (6% vs 14%, p<0.001). One-year composite major adverse cardiovascular event, defined as death, Q-wave myocardial infarction, and target vessel revascularization, was 10% in the de novo group and 17% in the ISR group (hazard ratio 1.98, 95% confidential interval 1.58 to 2.46, p<0.001). After adjusting for myocardial infarction presentation, hazard ratio of major adverse cardiovascular events was still higher for the ISR group at 1 year (2.03, 95% confidential interval 1.62 to 2.55, p<0.001). ISR of DES remains a therapeutic challenge and leads to complex presentation and worse outcomes compared with matched de novo patients. These data show that DES-ISR demands better appreciation and prevention with more precise stent technique and should motivate the continued development of fully bioresorbable scaffolds.All authors: Ben-Dor I, Buchanan KD, Gai J, Rogers T, Satler LF, Suddath WO, Torguson R, Waksman R, Xu LFiscal year: FY2018Digital Object Identifier: Date added to catalog: 2018-05-08
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 29627111 Available 29627111

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

Copyright (c) 2018 Elsevier Inc. All rights reserved.

Drug-eluting stents (DES) significantly reduced the incidence of in-stent restenosis (ISR). However, ISR still exists in the contemporary DES era. Previously deemed to be a benign process, ISR leads to complex presentation and intervention. This study aimed to compare the presentation and outcome of DES-ISR versus de novo lesions. We performed a retrospective analysis of 11,666 patients receiving percutaneous coronary intervention from 2003 to 2017 and divided them into 2 groups by de novo stenosis and ISR. They were matched based on common cardiovascular risk factors at a 4:1 ratio, respectively. After matching, a total of 1,888 patients with 3,126 de novo lesions and 472 patients with 508 ISR lesions were analyzed. Patients with ISR presented more often with unstable angina (61% vs 45%, p<0.001) and less often with myocardial infarction (6% vs 14%, p<0.001). One-year composite major adverse cardiovascular event, defined as death, Q-wave myocardial infarction, and target vessel revascularization, was 10% in the de novo group and 17% in the ISR group (hazard ratio 1.98, 95% confidential interval 1.58 to 2.46, p<0.001). After adjusting for myocardial infarction presentation, hazard ratio of major adverse cardiovascular events was still higher for the ISR group at 1 year (2.03, 95% confidential interval 1.62 to 2.55, p<0.001). ISR of DES remains a therapeutic challenge and leads to complex presentation and worse outcomes compared with matched de novo patients. These data show that DES-ISR demands better appreciation and prevention with more precise stent technique and should motivate the continued development of fully bioresorbable scaffolds.

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