Clinical presentation and outcomes of coronary in-stent restenosis across 3-stent generations.
Clinical presentation and outcomes of coronary in-stent restenosis across 3-stent generations.
Available online from MWHC library: 2008 - present
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. 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.Copyright � 2014 American Heart Association, Inc. 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).
English
1941-7640
*Acute Coronary Syndrome/th [Therapy]
*Angina, Unstable/th [Therapy]
*Coronary Artery Disease/th [Therapy]
*Coronary Stenosis/et [Etiology]
*Myocardial Infarction/th [Therapy]
*Percutaneous Coronary Intervention/ae [Adverse Effects]
*Percutaneous Coronary Intervention/is [Instrumentation]
*Stents
Acute Coronary Syndrome/di [Diagnosis]
Acute Coronary Syndrome/mo [Mortality]
Aged
Angina, Unstable/di [Diagnosis]
Angina, Unstable/mo [Mortality]
Chi-Square Distribution
Coronary Artery Disease/di [Diagnosis]
Coronary Artery Disease/mo [Mortality]
Coronary Stenosis/di [Diagnosis]
Coronary Stenosis/mo [Mortality]
Coronary Stenosis/pc [Prevention & Control]
Drug-Eluting Stents
Female
Humans
Kaplan-Meier Estimate
Logistic Models
Male
Metals
Middle Aged
Multivariate Analysis
Myocardial Infarction/di [Diagnosis]
Myocardial Infarction/mo [Mortality]
Odds Ratio
Percutaneous Coronary Intervention/mo [Mortality]
Proportional Hazards Models
Prosthesis Design
Protective Factors
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
MedStar Heart & Vascular Institute
Comparative Study
Journal Article
Observational Study
Available online from MWHC library: 2008 - present
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. 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.Copyright � 2014 American Heart Association, Inc. 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).
English
1941-7640
*Acute Coronary Syndrome/th [Therapy]
*Angina, Unstable/th [Therapy]
*Coronary Artery Disease/th [Therapy]
*Coronary Stenosis/et [Etiology]
*Myocardial Infarction/th [Therapy]
*Percutaneous Coronary Intervention/ae [Adverse Effects]
*Percutaneous Coronary Intervention/is [Instrumentation]
*Stents
Acute Coronary Syndrome/di [Diagnosis]
Acute Coronary Syndrome/mo [Mortality]
Aged
Angina, Unstable/di [Diagnosis]
Angina, Unstable/mo [Mortality]
Chi-Square Distribution
Coronary Artery Disease/di [Diagnosis]
Coronary Artery Disease/mo [Mortality]
Coronary Stenosis/di [Diagnosis]
Coronary Stenosis/mo [Mortality]
Coronary Stenosis/pc [Prevention & Control]
Drug-Eluting Stents
Female
Humans
Kaplan-Meier Estimate
Logistic Models
Male
Metals
Middle Aged
Multivariate Analysis
Myocardial Infarction/di [Diagnosis]
Myocardial Infarction/mo [Mortality]
Odds Ratio
Percutaneous Coronary Intervention/mo [Mortality]
Proportional Hazards Models
Prosthesis Design
Protective Factors
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
MedStar Heart & Vascular Institute
Comparative Study
Journal Article
Observational Study