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

by Magalhaes, Marco A; Minha, Sa'ar; Chen, Fang; Torguson, Rebecca; Omar, Al Fazir; Loh, Joshua P; Escarcega, Ricardo O; Lipinski, Michael J; Baker, Nevin C; Kitabata, Hironori; Ota, Hideaki; Suddath, William O; Satler, Lowell F; Pichard, Augusto D; Waksman, Ron.
Citation: Circulation: Cardiovascular Interventions. 7(6):768-76, 2014 Dec..Journal: Circulation. Cardiovascular interventions.ISSN: 1941-7640.Full author list: Magalhaes MA; Minha S; Chen F; Torguson R; Omar AF; Loh JP; Escarcega RO; Lipinski MJ; Baker NC; Kitabata H; Ota H; Suddath WO; Satler LF; Pichard AD; Waksman R.UI/PMID: 25466551.Subject(s): Acute Coronary Syndrome/di [Diagnosis] | Acute Coronary Syndrome/mo [Mortality] | *Acute Coronary Syndrome/th [Therapy] | Aged | Angina, Unstable/di [Diagnosis] | Angina, Unstable/mo [Mortality] | *Angina, Unstable/th [Therapy] | Chi-Square Distribution | Coronary Artery Disease/di [Diagnosis] | Coronary Artery Disease/mo [Mortality] | *Coronary Artery Disease/th [Therapy] | Coronary Stenosis/di [Diagnosis] | *Coronary Stenosis/et [Etiology] | 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] | *Myocardial Infarction/th [Therapy] | Odds Ratio | *Percutaneous Coronary Intervention/ae [Adverse Effects] | *Percutaneous Coronary Intervention/is [Instrumentation] | Percutaneous Coronary Intervention/mo [Mortality] | Proportional Hazards Models | Prosthesis Design | Protective Factors | Retrospective Studies | Risk Assessment | Risk Factors | *Stents | Time Factors | Treatment OutcomeInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Comparative Study | Journal Article | Observational StudyOnline resources: Click here to access online Digital Object Identifier: http://dx.doi.org/10.1161/CIRCINTERVENTIONS.114.001341 (Click here) Abbreviated citation: Circ., Cardiovasc. interv.. 7(6):768-76, 2014 Dec.Local Holdings: Available online from MWHC library: 2008 - present.Abstract: 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.Abstract: 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).Abstract: 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.

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