TY  - BOOK
AU  - Ben-Dor, Itsik
AU  - Buchanan, Kyle
AU  - Gai, Jiaxiang
AU  - Rogers, Toby
AU  - Satler, Lowell F
AU  - Suddath, William O
AU  - Torguson, Rebecca
AU  - Waksman, Ron
AU  - Xu, Linzhi
TI  - In-Stent Restenosis of Drug-Eluting Stents Compared With a Matched Group of Patients With De Novo Coronary Artery Stenosis
SN  - 0002-9149
PY  - 2018///
KW  - *Angina, Unstable/ep [Epidemiology]
KW  - *Coronary Restenosis/ep [Epidemiology]
KW  - *Coronary Stenosis/ep [Epidemiology]
KW  - *Drug-Eluting Stents
KW  - *Mortality
KW  - *Myocardial Infarction/ep [Epidemiology]
KW  - *Myocardial Revascularization/sn [Statistics & Numerical Data]
KW  - Acute Coronary Syndrome/ep [Epidemiology]
KW  - Aged
KW  - Cardiovascular Diseases/mo [Mortality]
KW  - Coronary Restenosis/pp [Physiopathology]
KW  - Coronary Stenosis/pp [Physiopathology]
KW  - Coronary Stenosis/su [Surgery]
KW  - Female
KW  - Humans
KW  - Male
KW  - Middle Aged
KW  - Neointima
KW  - Percutaneous Coronary Intervention
KW  - Proportional Hazards Models
KW  - Retrospective Studies
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
N1  - Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
N2  - 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
UR  - https://dx.doi.org/10.1016/j.amjcard.2018.02.033
ER  -