Abstract 17829: Optimal Treatment of Recurrent Restenosis Lesions After Sirolimus-Eluting Stent Implantation for In-Stent Restenosis Lesions
Backgrounds: Several studies have reported the outcomes of various treatment modalities for in-stent restenosis (ISR) after sirolimus-eluting stent (SES) implantation. However, there is no data available on the optimal treatment of recurrent ISR lesions after SES implantation for ISR lesions.
Methods: From 2003 to 2010, SES was implanted in 812 ISR lesions, of which 144 recurrent ISR lesions (137 patients) were treated with balloon angioplasty (BA: 79 lesions, 74 patients) and drug-eluting stent (DES: 65 lesions, 63 patients) implantation. Clinical outcomes were evaluated for target lesion revascularization (TLR) and major adverse cardiac events (MACE), including a composite of death, myocardial infarction, and TLR.
Results: Clinical follow-up was performed in all patients and the median follow-up duration was 1079 days (interquartile range 620 to 1684). The figure shows that the MACE free rate was significantly higher in DES than BA, mainly because of higher TLR rate in DES. Multivariate analysis revealed that BA is an independent predictor of MACE (odds ratio [OR] 7.18, 95% confidence interval [CI] 3.23-16.6, p<0.001) and TLR (OR 5.97, 95%CI 2.70-14.0, p<0.001). When the patients with recurrent ISR lesions were morphologically divided into two groups: focal (60 patients) and nonfocal (77 patients), the incidence of TLR was lower in DES implantation than BA in both groups (focal: 20.6% vs 46.5%, p=0.03; nonfocal: 31.0% vs 77.4%, p<0.001).
Conclusions: DES implantation is more effective than BA in the treatment of recurrent ISR lesions, whether the morphologic pattern is focal or nonfocal.
- © 2012 by American Heart Association, Inc.