Author + information
- Jay Shavadia1,
- Karen Chiswell2,
- Roseann White3,
- Leslie Stephens4,
- Tanya Schikorr5,
- Prajakta Bhounsule5 and
- Mitchell Krucoff6
- 1Duke Clinical Research Institute, Durham, North Carolina, United States
- 2Duke Clinical Research Institute, Durham, North Carolina, United States
- 3DCRI, Durham, North Carolina, United States
- 4Abbott Vascular, Santa Clara, California, United States
- 5Abbott Vascular, Santa Clara, California, United States
- 6Duke University Medical Center/Duke Clinical Research Institute, Durham, North Carolina, United States
In-stent restenosis accounts for a significant proportion of PCI re-interventions. In an era of improved PCI outcomes with superior devices and medical therapy, a real world understanding of ISR prevalence and treatment patterns is necessary.
In consecutive adult patients (≥ 18 years age) undergoing PCI within the Duke Databank for Cardiovascular Disease from July 2009 – March 2015, we retrospectively characterize all unique ISR percutaneous coronary intervention (ISR PCI) in comparison to non-ISR PCI.
Of a total 5318 unique PCI procedures (in 4466 patients), repeat PCI accounted for 2064 (39%) interventions in whom ISR PCI was performed in 400 (19%, 7.5% of all PCI procedures). In ISR PCI, the median (25th, 75th) duration from prior PCI was 1.1 (0.4, 3.8) years, with limited between-year variability. Acute MI accounted for 36% of all ISR PCI presentations. In comparison to non-ISR PCI, ISR PCI patients had comparable age and sex distribution, greater cardiovascular comorbidities, and twice as likely to have a chronic total occlusion. Relative to a reduction in overall PCI volume over time, ISR PCI rates remained relatively constant (7.5% of all PCI cases overall, annualized 4-9%, Figure). Overall, stents were utilized less frequently with ISR PCI as compared to non-ISR PCI (83.8% vs. 97.0%, p<0.01), however, when used, a greater proportion of drug eluting (DES) over bare metal stent is noted (81.5% vs. 59.3%, p<0.01)
Two in every five PCIs at a single center is a repeat procedure, and one in every five repeat PCI procedures is related to ISR, performed at a median 1-year from prior PCI. Despite stenting being utilized less frequently in ISR compared to non-ISR PCI, repeat stenting is utilized in > 80% of ISR treatments. The long-term outcomes of further stenting for ISR treatment needs to be evaluated in the context of the overall existing metal burden. Treatment options that reduce the burden of metal in ISR patients are needed.
CORONARY: PCI Outcomes