Abstract 16143: Limited Value of Traditional Restenosis Predictors after Recurrent Drug-eluting Stent Failure
Background: Therapeutic options to treat in-stent restenosis (ISR) after initial therapy with a drug-eluting stent (DES) include repeat DES implantation, vascular brachytherapy (VBT) or conventional angioplasty. However, the optimal treatment for this condition remains unclear. This study aimed to assess the predictors for recurrent DES failure and clinical outcomes after a first DES failure.
Methods: From 2003 to 2007, 564 patients presenting with angiographic ISR after DES implantation were included. Of these, 415 patients completed 1-year follow-up. The primary endpoint was defined as clinically driven target lesion revascularization at 1-year follow up.
Results: This population presented a high prevalence of comorbidities, including prior myocardial infarction (46.0%), diabetes (43.6%), chronic renal failure (18.8%) and heart failure (17.3%). Patients presented most commonly with unstable angina (63.2%) and silent ischemia (24.9%). Patients were treated by new-DES implantation (n=334), VBT (n=131) and conventional angioplasty (n=98). The overall rate of diffuse ISR (length >10 mm) was 49.9%. However, patients undergoing VBT presented more frequently with diffuse ISR (63%) than those treated with re-DES (49%) or conventional angioplasty (34%) (p <0.001). The overall incidence of recurrent DES failure at 1-year follow-up was 12.9% (n=53). The rates of clinical outcomes were not significantly different among the 3 groups at 1-year follow-up. (Table) After adjustment using the traditional known covariates related with ISR, none of the tested variables predicts 1-year TLR.
Conclusions: Recurrence of ISR after DES treatment failure is not benign and remains challenging independent of the treatment modality. The absence of the traditional predictors for ISR in this population invokes the presence of unrecognized predisposal conditions.
- © 2010 by American Heart Association, Inc.