Author + information
- Rebecca Torguson1,
- Corey Shea2,
- Kyle Buchanan1,
- Linzhi Xu3,
- Itsik Ben-Dor4,
- Lowell Satler1 and
- Ron Waksman4
- 1Washington Hospital Center, Washington, District of Columbia, United States
- 2MedStar Washington Hospital Center, Washington, DC, District of Columbia, United States
- 3MedStar Washington Hospital Center, Washington, District of Columbia, United States
- 4Medstar Washington Hospital Center, Washington, District of Columbia, United States
Drug eluting stents (DES) reduce the incidence of in-stent restenosis (ISR). Nevertheless, there has been continued utility of bare metal stents (BMS) throughout the era of DES. Even with the best in class DES, ISR continues to occur and remains a therapeutic challenge. The current analysis sought to evaluate the clinical presentation and outcomes of patients who present with BMS vs DES ISR.
The study cohort included 1865 patients who have presented with ISR since 2003 and entered the REWARDS ISR Registry. In these patients, the type of ISR stent could be identified and at least 1 year of follow-up was available. Overall, there were 842 patients who presented with BMS ISR and 1023 with DES ISR. Follow-up outcome was defined as the composite of death, Q-wave myocardial infarction and target vessel revascularization.
Overall, at the time of ISR presentation, the two groups were well matched with no statistical difference between the two groups. The population was predominantly male (66%) and Caucasian (62.1%). Prior history of hypertension (93.8%), hyperlipidemia (94.9%), peripheral vascular disease (21.5%), renal insufficiency (20.5%), current smoking (18.3%) and prior CABG (34.4%) were similar; however there was a higher prevalence of diabetes in the DES ISR group (40.9% vs 49.7%, p<0.001). The clinical presentations with acute myocardial infarction and unstable angina were also similar overall (13.3% and 55.6%, respectively). Despite very similar risk factor profiles and clinical presentations with ISR the 1 year outcomes are worse for those who present with DES ISR as compared to BMS ISR (MACE: 26.4% vs 19.7%, p<0.001).
Despite the similarities in clinical presentation and risk factors between the BMS and DES groups, DES ISR is associated with worse outcomes at 1 year. There is still room to improve the stent technology of DES to minimize ISR; and focus efforts to achieve optimal therapeutic strategies if ISR does occur.
CORONARY: Stents: Bare Metal