Clinical presentation and outcomes of coronary in-stent restenosis across 3-stent generations.
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
Item type | Current library | Collection | Call number | Status | Date due | Barcode |
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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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