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Clinical presentation and outcomes of coronary in-stent restenosis across 3-stent generations.
Circ Cardiovasc Interv 2014; 7(6):768-76CC

Abstract

BACKGROUND

Clinical presentation of bare metal stent in-stent restenosis (ISR) in patients undergoing target lesion revascularization is well characterized and negatively affects on outcomes, whereas the presentation and outcomes of first- and second-generation drug-eluting stents (DESs) remains under-reported.

METHODS AND RESULTS

The study included 909 patients (1077 ISR lesions) distributed as follows: bare metal stent (n=388), first-generation DES (n=425), and second-generation DES (n=96), categorized into acute coronary syndrome (ACS) or non-ACS presentation mode at the time of first target lesion revascularization. ACS was further classified as myocardial infarction (MI) and unstable angina. For bare metal stent, first-generation DES and second-generation DES, ACS was the clinical presentation in 67.8%, 71.0%, and 66.7% of patients, respectively (P=0.470), whereas MI occurred in 10.6%, 10.1%, and 5.2% of patients, respectively (P=0.273). The correlates for MI as ISR presentation were current smokers (odds ratio, 3.02; 95% confidence interval [CI], 1.78-5.13; P<0.001), and chronic renal failure (odds ratio, 2.73; 95% CI, 1.60-4.70; P<0.001), with a protective trend for the second-generation DES ISR (odds ratio, 0.35; 95% CI, 0.12-1.03; P=0.060). ACS presentations had an independent effect on major adverse cardiac events (death, MI, and re-target lesion revascularization) at 6 months (MI versus non-ACS: adjusted hazard ratio, 4.06; 95% CI, 1.84-8.94; P<0.001; unstable angina versus non-ACS: adjusted hazard ratio, 1.98; 95% CI, 1.01-3.87; P=0.046).

CONCLUSIONS

ISR clinical presentation is similar irrespective of stent type. MI as ISR presentation seems to be associated with patient and not device-related factors. ACS as ISR presentation has an independent effect on major adverse cardiac events, suggesting that ISR remains a hazard and should be minimized.

Authors+Show Affiliations

From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC.From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC.From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC.From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC.From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC.From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC.From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC.From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC.From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC.From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC.From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC.From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC.From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC.From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC.From the Division of Cardiology, Department of Internal Medicine, MedStar Washington Hospital Center, DC. ron.waksman@medstar.net.

Pub Type(s)

Comparative Study
Journal Article
Observational Study

Language

eng

PubMed ID

25466551

Citation

Magalhaes, Marco A., et al. "Clinical Presentation and Outcomes of Coronary In-stent Restenosis Across 3-stent Generations." Circulation. Cardiovascular Interventions, vol. 7, no. 6, 2014, pp. 768-76.
Magalhaes MA, Minha S, Chen F, et al. Clinical presentation and outcomes of coronary in-stent restenosis across 3-stent generations. Circ Cardiovasc Interv. 2014;7(6):768-76.
Magalhaes, M. A., Minha, S., Chen, F., Torguson, R., Omar, A. F., Loh, J. P., ... Waksman, R. (2014). Clinical presentation and outcomes of coronary in-stent restenosis across 3-stent generations. Circulation. Cardiovascular Interventions, 7(6), pp. 768-76. doi:10.1161/CIRCINTERVENTIONS.114.001341.
Magalhaes MA, et al. Clinical Presentation and Outcomes of Coronary In-stent Restenosis Across 3-stent Generations. Circ Cardiovasc Interv. 2014;7(6):768-76. PubMed PMID: 25466551.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical presentation and outcomes of coronary in-stent restenosis across 3-stent generations. AU - Magalhaes,Marco A, AU - Minha,Sa'ar, AU - Chen,Fang, AU - Torguson,Rebecca, AU - Omar,Al Fazir, AU - Loh,Joshua P, AU - Escarcega,Ricardo O, AU - Lipinski,Michael J, AU - Baker,Nevin C, AU - Kitabata,Hironori, AU - Ota,Hideaki, AU - Suddath,William O, AU - Satler,Lowell F, AU - Pichard,Augusto D, AU - Waksman,Ron, Y1 - 2014/12/02/ PY - 2014/12/4/entrez PY - 2014/12/4/pubmed PY - 2015/8/28/medline KW - drug-eluting stents KW - restenosis KW - stents SP - 768 EP - 76 JF - Circulation. Cardiovascular interventions JO - Circ Cardiovasc Interv VL - 7 IS - 6 N2 - BACKGROUND: Clinical presentation of bare metal stent in-stent restenosis (ISR) in patients undergoing target lesion revascularization is well characterized and negatively affects on outcomes, whereas the presentation and outcomes of first- and second-generation drug-eluting stents (DESs) remains under-reported. METHODS AND RESULTS: The study included 909 patients (1077 ISR lesions) distributed as follows: bare metal stent (n=388), first-generation DES (n=425), and second-generation DES (n=96), categorized into acute coronary syndrome (ACS) or non-ACS presentation mode at the time of first target lesion revascularization. ACS was further classified as myocardial infarction (MI) and unstable angina. For bare metal stent, first-generation DES and second-generation DES, ACS was the clinical presentation in 67.8%, 71.0%, and 66.7% of patients, respectively (P=0.470), whereas MI occurred in 10.6%, 10.1%, and 5.2% of patients, respectively (P=0.273). The correlates for MI as ISR presentation were current smokers (odds ratio, 3.02; 95% confidence interval [CI], 1.78-5.13; P<0.001), and chronic renal failure (odds ratio, 2.73; 95% CI, 1.60-4.70; P<0.001), with a protective trend for the second-generation DES ISR (odds ratio, 0.35; 95% CI, 0.12-1.03; P=0.060). ACS presentations had an independent effect on major adverse cardiac events (death, MI, and re-target lesion revascularization) at 6 months (MI versus non-ACS: adjusted hazard ratio, 4.06; 95% CI, 1.84-8.94; P<0.001; unstable angina versus non-ACS: adjusted hazard ratio, 1.98; 95% CI, 1.01-3.87; P=0.046). CONCLUSIONS: ISR clinical presentation is similar irrespective of stent type. MI as ISR presentation seems to be associated with patient and not device-related factors. ACS as ISR presentation has an independent effect on major adverse cardiac events, suggesting that ISR remains a hazard and should be minimized. SN - 1941-7632 UR - https://www.unboundmedicine.com/medline/citation/25466551/Clinical_presentation_and_outcomes_of_coronary_in_stent_restenosis_across_3_stent_generations_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCINTERVENTIONS.114.001341?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -