Abstract 14798: Predictors Of Late Target Lesion Revascularization After Sirolimus-eluting Stent Implantation
Purpose: In long term follow-up after drug-eluting stents (DES) implantation, some patients received late target lesion revascularization (TLR). Late TLR has not been fully investigated with DES. We evaluated the incidence and predictors of late TLR after sirolimus-eluting stent (SES) implantation.
Methods: Between August 2004 and March 2005, consecutive 249 patients underwent percutaneous coronary intervention with SES at our institution. Angiographic follow-up was obtained in 228 patients (91.6%) with 274 lesions (91.6%) at 8 months. Excluding 35 patients (15.4%) with 44 lesions (16.1%) underwent TLR based on follow-up angiographic results and ischemic evaluations, late TLR were retrospectively evaluated up to 5 years by clinical records or telephone contact in 193 patients with 229 lesions.
Results: Five-year clinical follow-up was obtained in 187 patients (96.9%) with 220 lesions (96.0%). The incidence of late TLR from 8 months to 5 years was 10.0% (Figure). Compared to patients with non-TLR, insulin required diabetes (4.2% vs. 21.0%, p = 0.003) and hemodialysis (7.1% vs. 21.0%, p= 0.04) were more frequent in patients with late TLR. We found no significant 8-month follow-up angiographic parameters associated with late TLR (minimal lumen diameter: 2.69 ± 0.53mm vs. 2.57 ± 0.69mm, p = 0.52; diameter stenosis: 17.1 ± 11.0% vs. 19.4 ± 19.6%, p = 0.52). Multivariate analysis identified insulin required diabetes was the independent predictor of late TLR (odds ratio = 6.13, 95% confidence interval = 1.61 to 23.37, p = 0.008).
Conclusions: Late TLR after SES implantation occurred in about 2.5% lesions per year after 8 months and the rate has not been reduced by time. Follow-up angiographic parameters did not predict late TLR. Only insulin required diabetes was the predictor of late TLR.
- © 2011 by American Heart Association, Inc.