A History of Prior Bare Metal Stent Restenosis Is Associated with Major Adverse Cardiac Events in Subsequent Bare Metal Stenting of de novo Coronary Lesions

Abstract

Objective: To investigate the risk of major adverse cardiac events (MACE) in patients with a history of bare metal stent (BMS) restenosis who undergo subsequent bare metal stenting of a geographically distinct, de novo coronary lesion. Methods: We conducted a retrospective review of 72 BMS procedures performed in geographically distinct, de novo coronary lesions in patients with a history of previous BMS placement at least 3 months prior to the second, index stent procedure. Patients with a history of in-stent restenosis (ISR) were compared with those who had no ISR in their initial stent. Results: Restenosis in the initial BMS was associated with a significant increase in MACE after placement of the index BMS (OR 20.0, 95% CI 3.86–103.58, p < 0.0001). This association was independent of traditional clinical and angiographic risk factors for restenosis. Conclusions: Restenosis of a previously placed BMS is strongly associated with MACE after placement of a subsequent BMS in a de novo coronary lesion.

Prior Bare Metal Stent Restenosis as a Predictor for Subsequent Restenosis: The Lightning Often Strikes Twice

“…Yet, these conclusions may be helpful to interventional cardiologists who are daily discussing and debating what the optimal intra-coronary device for the individual patient is: DES or BMS? The findings of Ferguson et al [1] are supported by those of previous studies that reported higher rates of restenosis in patients with a previous history of restenosis in a different coronary location [2,3] , or one may say 'restenosers'. However, the present report is the first to deal solely with repeated BMS restenosis.…”

“…The findings of the study by Ferguson et al [1] are of clinical importance to the daily decision-making in the catheterization laboratory. They provide us with a solid clinical parameter to detect patients that would benefit from DES rather than BMS.…”

“…Any additional predictors for ISR occurrence are important to help the interventional cardiologist in reaching an intelligent and evidence-based decision as to the type of stent implanted. In the current issue of Cardiology , Ferguson et al [1] report that previous restenosis following BMS implantation is a strong and independent predictor of further BMS restenosis. The investigators retrospec- was reported in less than 8% of the patients [4] .…”

Comparing clinical outcomes for a twelve-month trial of zotarolimus- and everolimus-eluting stents in patients with coronary artery disease: data from the THCRIC registry

“…Initially the bare-metal stent (BMS) reduced the rate of restenosis. However, the BMS was associated with a high rate of in-stent restenosis that usually developed within 3–12 months of initial stent implantation [Ferguson et al 2010]. Previously published randomized controlled trials have shown lower rates of clinical and angiographic restenosis and major adverse cardiac events with the drug-eluting stent (DES) [Indolfi et al 2005; Tanabe et al 2003; Colombo et al 2003; Ong et al 2005; Morice et al 2002; Hermiller et al 2005; Bavry et al 2005].…”