Author + information
- Issam Moussa1,
- Gregg Stone2,
- Paul Teirstein3,
- Kevin Kennedy4,
- Martin Leon5,
- Antonio Colombo6,
- Robert Yeh7,
- Jeffrey W. Moses8 and
- John Spertus9
- 1Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
- 2Cardiovascular Research Foundation, Columbia University Medical Center/NewYork-Presbyterian Hospital, NY, NY, United States
- 3Scripps Clinic and Research Foundation, La Jolla, California, United States
- 4University of Missouri Kansas City and Mid America Heart Institute, Kansas City, Missouri, United States
- 5Columbia University Medical Center/NewYork-Presbyterian Hospital, NY, NY, United States
- 6Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Milan, Italy
- 7Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- 8NewYork-Presbyterian Hospital/Columbia University Medical Center, NY, NY, United States
- 9Mid America Heart Institute, Kansas City, Missouri, United States
Drug-eluting stents (DES) have substantially reduced in-stent restenosis (ISR) compared to bare metal stents (BMS). However, limited data are available with regard to the burden of ISR in the United States, as well as its clinical presentation and treatment strategies.
Using the CathPCI National Cardiovascular Data Registry (CathPCI NCDR), we sought to provide an in-depth analysis of the temporal trends of ISR in the United States, as well as its clinical presentation, treatment strategies and in-hospital outcome.
Between 2009and2017, 5,100,394 pts underwent PCI, 542,112 (10.6%) of which were for ISR. The original stent in the ISR lesion was a DES in 295,489 pts (54%) (DES ISR), a BMS in 86,111 pts (16%) (BMS ISR), and unknown stent type in 160,512 pts (30%) (undefined ISR). The annual rate of ISR PCI was constant over time, ranging from 10.1% in 2009 Q3 to 10.8% in 2017 Q2 (Figure 1). The rates of pts with BMS ISR declined from 5.4% in 2009 Q3 to 0.9% in 2017 Q2 [P<0.001] with DES ISR rose from 5.4% in 2009 Q3 to 6.3% in 2017 Q2 [P<0.001], and with undefined ISR rose from 2.2% in 2009 Q3 to 3.7% in 2017 Q2 [P<0.001]. Pts undergoing ISR PCI presented with NSTEMI and STEMI in 18.7% and 8.5% of pts, respectively. Approximately half of the ISR PCI patients presented >2 years after the original stent implantation. Pts with DES ISR were more likely to present after the 1st year than patients with BMS ISR (66% vs. 61%, P<0.001). Pts undergoing ISR PCI were most commonly treated with another stent (82.6%), often a DES (93.1%), less commonly with PTCA or atherectomy only (17%), and rarely with brachytherapy (0.3%). A propensity-matched comparison of in-hospital outcomes of non ISR PCI vs. ISR PCI showed no difference in mortality (0.6% vs. 0.5%, P=ns), myocardial infarction (1.8% vs. 1.6%, P=ns), or stroke (0.2% vs. 0.2%, P=ns).
1) ISR represented ∼10% of all PCI procedures in the US, and the proportion of ISR procedures is slightly increasing over time despite improved stents; 2) more than 1 in 4 patients undergoing ISR PCI presents with a NSTEMI or a STEMI; 3) the most common treatment for ISR is implanting a 2nd stent, almost always a DES; and 4) in-hospital outcomes of ISR PCI are similar to that of non-ISR PCI. Improved technology is required to reduce the burden of ISR.
CORONARY: Stents: Drug-Eluting