Author + information
- Kyle Buchanan1,
- M. Chadi Alraies2,
- Toby Rogers2,
- Arie Steinvil3,
- Edward Koifman2,
- Linzhi Xu2,
- Rebecca Torguson1,
- Itsik Ben-Dor4,
- Augusto Pichard1,
- William Suddath4,
- Lowell Satler1 and
- Ron Waksman4
- 1Washington Hospital Center, Washington, District of Columbia, United States
- 2MedStar Washington Hospital Center, Washington, District of Columbia, United States
- 3Medstar Washington Hospital center, Washington DC, USA, Washington, District of Columbia, United States
- 4Medstar Washington Hospital Center, Washington, District of Columbia, United States
Drug-eluting stents (DES) have significantly improved the rate of in-stent restenosis (ISR) following percutaneous coronary intervention (PCI). However, ISR remains a therapeutic challenge, often leading to recurrent ISR. The aim of this study was to compare patients with a single DES ISR event to patients with multiple DES ISR events.
We performed a retrospective analysis of patients receiving PCI for treatment of DES ISR from 2003 to 2017. The patients were separated by number of ISR presentations. The Single ISR group had one presentation compared to the Multiple ISR group, which had more than one presentation of ISR of the same lesion.
A total of 489 patients were analyzed. 216 patients had one presentation of ISR and 273 patients had multiple presentations for ISR. 331 (68%) were male with mean age of 65±11 years and no significant difference between the two groups. There was also no difference between the groups in regards to cardiovascular risk factors. The Single ISR group presented more often with MI (8% vs 4%, p=0.027) but there was no difference in angina. The Single ISR group was more often treated with DES (58% vs 23%, p<0.001) while brachytherapy was more often used to treat Multiple ISR (57% vs 17%, p<0.001). There was no difference in composite death, Q-wave MI, and target vessel revascularization (TVR) at one year between the groups, 17% vs 16% (HR 1.12 95% CI 0.77-1.62, p=0.560). However, after adjusting for MI presentation, composite death, Q-wave MI, and TVR was higher in the Multiple ISR group (HR 2.45, 95% CI 1.34-4.47, p = 0.004).
There is no difference in clinical characteristics between patients with one episode of ISR and multiple episodes of ISR. ISR of DES remains a challenge with poor outcomes that are worse following recurrent ISR when adjusting for MI. Lesion-level characteristics are likely more predictive of DES ISR and efforts should focus on minimizing recurrent ISR.
CORONARY: Stents: Drug-Eluting