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

Abstract

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).

Development and validation of a risk prediction nomogram for in-stent restenosis in patients undergoing percutaneous coronary intervention

“…In another study evaluating the incidence and predictors of target vessel revascularization among 27,107 patients undergoing implantation of BMS or DES, significant predictors of restenosis included prior PCI, emergency or salvage PCI, prior coronary artery bypass grafting (CABG), peripheral vascular disease, diabetes mellitus (DM), and angiographic characteristics [ 8 ]. Lately, Zheng et al [ 21 ] analyzed 944 stented lesions from 394 patients with 2nd-generation DES implantation. Factors including DM, previous PCI, postprocedural diameter stenosis and CRP levels were found to independently predict target lesion revascularization.…”

A Simple Model to Predict Repeat Revascularization After Drug-Eluting Stent Implantation in Patients With Stable Coronary Artery Disease

“…Previous studies [18][19][20] have reported the predictors of target lesion or target vessel revascularization in certain populations, and these predictors were found to be different at different time intervals. 18 However, to our knowledge, few studies have focused on the risk factors for overall repeat revascularization.…”

“…Previous studies [18][19][20] have reported the predictors of target lesion or target vessel revascularization in certain populations, and these predictors were found to be different at different time intervals. 18 However, to our knowledge, few studies have focused on the risk factors for overall repeat revascularization. In the current study, we analyzed the predictors of repeat revascularization after DES implantation in patients with stable CAD using a relative large sample, thereby developing and validating an easy-to-use predictive model presented as a nomogram.…”

Diabetes and restenosis

“…Moreover, diabetic patients showed a more heterogenous pattern of the neointima after BMS, resulting in longer high-grade obstruction segments [144]. However, in the second-generation DES era, it remains somewhat controversial [145][146][147][148][149][150][151] whether DM (particularly T2DM) is still a statistically significant predictor of longterm adverse outcomes-including ISR, MACE, and late in-stent thrombosis after PCI (Table 1). This uncertainty may reflect the fact that the use of second-generation DES suppresses the difference in outcomes between those with and without DM.…”