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

MedStar author(s):
Citation: Circulation: Cardiovascular Interventions. 7(6):768-76, 2014 Dec.PMID: 25466551Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Comparative Study | Journal Article | Observational StudySubject headings: *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 OutcomeLocal holdings: Available online from MWHC library: 2008 - presentISSN:
  • 1941-7640
Name of journal: Circulation. Cardiovascular interventionsAbstract: 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).All authors: Baker NC, Chen F, Escarcega RO, Kitabata H, Lipinski MJ, Loh JP, Magalhaes MA, Minha S, Omar AF, Ota H, Pichard AD, Satler LF, Suddath WO, Torguson R, Waksman RDigital Object Identifier: Date added to catalog: 2016-01-13
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article Available 25466551

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).

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