Predictors of Early and Late Target Lesion Revascularization after Drug‐Eluting Stent Implantation

Choi, Ik Jun; Park, Hun‐Jun; Seo, Suk-Min; Koh, Yoon Seok; Lee, Jongmin; Chang, Kiyuk; Chung, Wook-Sung; Seung, Ki‐Bae; Kim, Pum-Joon

doi:10.1111/joic.12001

Cited by 10 publications

(7 citation statements)

References 28 publications

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“…ISR is primarily a nonspecific inflammatory response to vessel wall injury and the injured tissue reacts via an inflammatory process that leads to NIH, eventually leading to lumen narrowing. Regardless of the exact pathophysiology, ISR is the end result of endothelial injury caused by stent deployment and foreign materials left at the deployment site [16, 18–20]. Goto K et al retrospectively analyzed 298 ISR lesions using IVUS data.…”

Section: Discussionmentioning

confidence: 99%

“…Our data also showed that independent predictors for late TLR differed from the predictors of early TLR. Previous studies had suggested that the predictors of early TLR are MLD poststent implantation, saphenous vein graft, DM, RCA disease, family history of CAD, multivessel disease, stent diameter, etc., while insulin-treated DM, younger age, elevated serum hs-CRP levels, the first generation DES, stent fracture, stent diameter, and stent length are predictive predictors of late TLR [16, 23–25]. Some studies focused on early TLR which was evaluated at 8-12 months after PCI [25, 26], while other studies focused on late TLR, which was evaluated at 12-24 months after index PCI [23, 24].…”

Section: Discussionmentioning

confidence: 99%

“…One clinical study suggested that the risk factors for late TLR were similar to those of early TLR [15]. However, this study only included patients who received sirolimus eluting stent (SES) implantation and was limited by the profound selection bias that favored the use of BMS [16]. At present, there are few studies on predictors of both early and late TLR based on contemporary 2nd generation DESs; moreover, the predictors are not consistent.…”

Section: Introductionmentioning

confidence: 99%

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The Predictors of Target Lesion Revascularization and Rate of In-Stent Restenosis in the Second-Generation Drug-Eluting Stent Era

Zheng

Kang

Park

et al. 2019

Journal of Interventional Cardiology

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Objectives. The aim of our study was to investigate the predictors of target lesion revascularization (TLR) and to compare the in-stent restenosis (ISR) progression rates of different 2nd-generation drug-eluting stents (DES). Background. The predictors of early and late TLR after 2nd-generation DES implantation have not been fully evaluated. Methods. We analyzed 944 stented lesions from 394 patients who had at least two serial follow-up angiograms, using quantitative coronary angiography (QCA) analysis. The study endpoints were TLR and the velocity of diameter stenosis (DS) progression. Results. TLR occurred in 58 lesions (6.1%) during the first angiographic follow-up period and 23 de novo lesions (2.4%) during the following second interval. Independent predictors for early TLR were diabetes mellitus (DM) (HR 2.58, 95% CI 1.29–5.15, p=0.007), previous percutaneous coronary intervention (PCI) (HR 2.41, 95% CI 1.03–5.65, p=0.043), and postprocedure DS% (HR 1.08, 95% CI 1.05–1.11, p<0.001, per 1%), while predictors of late TLR were previous PCI (HR 9.43, 95% CI 2.58-34.52, p=0.001) and serum C-reactive protein (CRP) (HR 1.60, 95% CI 1.28-2.00, p<0.001). The ISR progression velocity (by DS%) was 12.1 ±21.0%/year and 3.7 ±10.1%/year during the first and second follow-up periods, respectively, which had no significant difference (p>0.05) between the four types of DESs. Conclusions. Our data showed that predictors for TLR may be different at different time intervals. DM, pervious PCI, and postprocedure DS could predict early TLR, while previous PCI and CRP level could predict late TLR. Contemporary DESs had similar rates of ISR progression rates. Trial Registration. This study was retrospectively registered and approved by the institutional review board of Seoul National University Hospital (no. 1801–138-918).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Predictors of Target Lesion Revascularization and Rate of In-Stent Restenosis in the Second-Generation Drug-Eluting Stent Era

Zheng

Kang

Park

et al. 2019

Journal of Interventional Cardiology

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“…PCI is performed to open the stenosis or occlusion of a coronary artery for improving myocardial perfusion of the patients with CHD and is an important method for the treatment of CHD. However, the subsequent in-stent restenosis remains a challenge for clinicians (20). In-stent restenosis involves a complex process with multiple factors including inflammatory responses, intimal hyperplasia, and vascular remodeling (21).…”

Section: Discussionmentioning

confidence: 99%

High levels of HB-EGF and interleukin-18 are associated with a high risk of in-stent restenosis

Hua¹,

Liu²,

Liu³

et al. 2015

Anatol J Cardiol

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Objective:To explore the clinical significance of heparin-binding epidermal growth factor-like growth factor (HB-EGF), interleukin-18 (IL-18), and interleukin-10 (IL-10) in restenosis after percutaneous coronary intervention (PCI).Methods:A total of 198 patients with acute coronary syndrome underwent coronary drug-eluting stent implantation and were divided into the restenosis group and non-restenosis group on the basis of second coronary angiography. Biological parameters and HB-EGF, IL-18, and IL-10 levels were measured. Patients in the restenosis group were further divided into 3 subgroups according to Gensini score: group A (Gensini score of <20), group B (Gensini score of >20 but <40), and group C (Gensini score of >40).Results:Compared with the non-restenosis group, HB-EGF and IL-18 levels were significantly higher but serum IL-10 levels were significantly lower in the restenosis group. Furthermore, HB-EGF levels increased with the Gensini score among the 3 subgroups. Spearman’s correlation analysis showed that HB-EGF levels were associated with IL-18 levels and the number of diseased vessels. Multivariate logistic regression analysis showed that diabetes, HB-EGF, and IL-18 were risk factors for restenosis [odds ratio with 95% confidence interval: 3.902 (1.188-4.415), 2.185 (1.103-4.014), and 2.079 (1.208-4.027), respectively].Conclusion:The present study has demonstrated that HB-EGF may be used to evaluate the severity of restenosis and coronary artery lesion and that inflammatory responses may be involved in the process of restenosis.

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“…[16] Predictors of late TLR after DES implantation include insulin-dependent diabetes mellitus, stent diameter, and first-generation DES. [17] Neointimal tissue growth in patients with late (after 1 year) in-stent restenosis following sirolimus-eluting stent implantation is characterized by a higher frequency of lipidladen neointimal, thin-cap fibroatherome-like neointimal, microchannels, and neointimal disruption, compared with that in patients with early (within 1 year) in-stent restenosis following the same stent. [18] To date, the exact mechanism of late in-stent restenosis following second-generation DES remains unclear.…”

Section: Efficacy Endpointmentioning

confidence: 98%

4-Year outcome of bioactive stents versus everolimus-eluting stents in acute coronary syndrome

Karjalainen

Niemelä

Pietilä

et al. 2016

Scandinavian Cardiovascular Journal

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Predictors of Early and Late Target Lesion Revascularization after Drug‐Eluting Stent Implantation

Cited by 10 publications

References 28 publications

The Predictors of Target Lesion Revascularization and Rate of In-Stent Restenosis in the Second-Generation Drug-Eluting Stent Era

The Predictors of Target Lesion Revascularization and Rate of In-Stent Restenosis in the Second-Generation Drug-Eluting Stent Era

High levels of HB-EGF and interleukin-18 are associated with a high risk of in-stent restenosis

4-Year outcome of bioactive stents versus everolimus-eluting stents in acute coronary syndrome

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