Clinical characteristics of early and late drug-eluting stent in-stent restenosis and mid-term prognosis after repeated percutaneous coronary intervention

Abstract

Background: The mechanism and characteristics of early and late drug-eluting stent in-stent restenosis (DES-ISR) have not been fully clarified. Whether there are different outcomes among those patients being irrespective of their repeated treatments remain a knowledge gap. Methods: A total of 250 patients who underwent initial stent implantation in our hospital, and then were readmitted to receive treatment for the reason of recurrent significant DES-ISR in 2016 were involved. The patients were categorized as early ISR (<12 months; E-ISR; n = 32) and late ISR (≥12 months; L-ISR; n = 218). Associations between patient characteristics and clinical performance, as well as clinical outcomes after a repeated percutaneous coronary intervention (PCI) were evaluated. Primary composite endpoint of major adverse cardiac events (MACEs) included cardiac death, non-fatal myocardial infarction (MI), or target lesion revascularization (TLR). Results: Most baseline characteristics are similar in both groups, except for the period of ISR, initial pre-procedure thrombolysis in myocardial infarction, and some serum biochemical indicators. The incidence of MACE (37.5% vs . 5.5%; P < 0.001) and TLR (37.5% vs . 5.0%; P < 0.001) is higher in the E-ISR group. After multivariate analysis, E-ISR (odds ratio [OR], 13.267; [95% CI 4.984–35.311]; P < 0.001) and left ventricular systolic dysfunction (odds ratio [OR], 6.317; [95% CI 1.145–34.843]; P = 0.034) are the independent predictors for MACE among DES-ISR patients in the mid-term follow-up of 12 months. Conclusions: Early ISR and left ventricular systolic dysfunction are associated with MACE during the mid-term follow-up period for DES-ISR patients. The results may benefit the risk stratification and secondary prevention for DES-ISR patients in clinical practice.

The association between the triglyceride-glucose index and in-stent restenosis in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis

“…However, stent implantation in the coronary artery can cause vascular injury and neointimal hyperplasia, leading to the occurrence of in-stent restenosis (ISR). According to reports, the occurrence of ISR in the new generation of drug-eluting stents is still about 3-10% [3,4], and approximately 25% of patients with ISR present with acute myocardial infarction [5]. Although the incidence of ISR is low, considering the large number of people undergoing stent implantation for revascularization and the poor prognosis of ISR, it is crucial to discover groups at high risk for ISR.…”

Comparative outcomes of MACE after Drug eluting balloon Vs. Drug Eluting Stent in treatment of in-stent restenosis (ISR) patients presented with acute coronary syndrome.

“…Vascular damage and the ensuing intima inflammation function as the first stimulus for multiplication and stimulation of vascular smooth muscle. As a result, myofibroblast move to create neointimal layer and extracellular matrix that is coated by endothelial cells above the stented section, leading to restenosis of the stent 4 . Additionally, a previous study identified the stent under-expansion as a significant possible ISR mechanism 5 .…”

The impact of J‐CTO score on in‐stent chronic total occlusion percutaneous coronary intervention

“…Although the success rate of CTO PCI reaches around 90% owing to the advancements in recanalisation techniques and devices, 1 IS‐CTO PCI always achieves lower success ratios of 63% to 71% 2‐5 mostly due to wire crossing difficulties from the presence of the stent and also potential stent under expansion. As is well known, PCI for non‐occlusive in‐stent restenosis (ISR) yields worse outcomes than those PCI in de novo lesions, even in the era of drug‐eluting stents (DES) 6‐8 . The pre‐existing artificial stent structure results in a considerably worst long‐term outcome for the IS‐CTO lesion than the de novo CTO.…”

“…yields worse outcomes than those PCI in de novo lesions, even in the era of drug-eluting stents (DES). [6][7][8] The pre-existing artificial stent structure results in a considerably worst long-term outcome for the IS-CTO lesion than the de novo CTO. IS-CTO has been identified as an independent predictor of target-vessel revascularisation (TVR).…”