Abstract 3040: Risk Factors for Re-Target Lesion Revascularization in Post Sirolimus-Eluting Stent Restenosis: Insights from j-CYPHER Registry
Background: Sirolimus-eluting stents (SES) enabled us to reduce restenosis and target lesion revascularization (TLR). Although marked increase in off-label use of SES may raise the possibility of elevation in SES restenosis rate, therapeutic strategy for SES restenosis remains to be established. Therefore, elucidating risk factors for re-TLR after treatment of SES restenosis with SES will help interventional cardiologists to take preventive measures for high risk patients.
Methods: The j-Cypher registry is a physician-directed multi-center registry in Japan enrolling consecutive patients undergoing SES implantation in 37 centers. Between August 2004 and November 2006, 17545 lesions were successfully treated with SES. Among 1183 restenotic lesions after SES implantation, we identified 484 lesions retreated with SES and examined 228 lesions followed up for 1 year. Logistic regression analysis was performed to determine clinical and procedural risk factors for re-TLR.
Results: During 1 year follow-up after 1st TLR for SES restenosis with SES, 2nd TLR occurred in 58 lesions (25.4%). After adjustment for other factors, only saphenous vein graft (SVG) lesion [odds ratio (OR), 6.30; 95% confidence interval (CI), 1.34 –29.62] was demonstrated as the independent risk factor for recurrence of TLR. Two stent technique [OR, 2.58; 95% CI, 0.85–7.80] showed a trend toward predicting 2nd TLR. Ostial lesion [OR, 0.35; 95% CI, 0.12–1.02] tended to contribute to no-2nd TLR. (Figure⇓)
Conclusions: In our study population, 2nd TLR occurred in 25.4% (58/228) during 1 year follow-up after 1st TLR for SES restenosis with SES. The only independent risk factor for re-TLR was revealed as SVG lesion.