Abstract 14038: In-Stent Restenosis (ISR) is Not Simply a Benign Clinical Entity as It Presents as an Acute Coronary Syndrome (ACS) in 40% of Cases
Background: ISR following stent implantation may occur in 20% to 40% of cases according to patient and lesion complexity. Previously, ISR used to be seen as a “benign” event, but recent studies suggest many patients with ISR may develop ACS as the first manifestation of this adverse event. The study aim was to determine the different clinical presentations of ISR in a large patient cohort compared with native coronary disease.
Methods: 14,445 consecutive patients underwent PCI at a single centre (2003-2010). 922 (6.4%) cases presented with restenosis after previous PCI. All patients with restenosis presented with new or recurrent symptoms. In hospital MACE (MI, urgent revascularisation, stroke or death) was documented at discharge. All cause mortality data was obtained via the BCIS/CCAD national audit upto 3.2 years (mean 3.1 +/-1.8 years).
Result: Restenosis presented in 60.4% as stable angina, 30.6% as unstable angina/NSTEMI and 9% with STEMI. Cardiogenic shock was reported in 6 patients (0.65%). Women had a higher incidence of unstable angina/NSTEMI compared with men (32.6% v. 29.1%) but a lower incidence of STEMI (5% v. 10.4%). Mortality rate was 0.98% at 30 days, 3.9% at 1 year and 8.7% at five years in patients with restenosis. Comparing the restenotic group with those undergoing PCI for de novo coronary artery disease, there were similar ages and incidence of cardiogenic shock but the restenotic group had higher rates of baseline risk factors (DM, hypertension, hyerpcholesterolaemia) and higher rates of previous CABG and MI. There was also a higher proportion of South Asians in the restenotic group. There were similar rates of inhospital MACE in the 2 groups and over a 5 year follow up period, there was no difference in all cause mortality. There was no difference in outcome of patients with ISR versus de novo coronary artery disease regardless of presentation (angina, UA/NSTEMI/STEMI).
Conclusions: ISR can frequently present as MI and such patients are more likely to have an aggressive angiographic pattern of restenosis. Drug-eluting stents with improved designs or drug elution systems that further decrease the incidence of ISR are needed.
- © 2011 by American Heart Association, Inc.