title: Correlates of failure following treatment with Sr-90 beta irradiation for in-stent restenosis.
abstract: We sought to determine the correlates of failure following intracoronary radiation therapy (IRT) with Sr-90 using the Novoste Beta-Cath system for the treatment of in-stent restenosis (ISR) in a broad range of patients. IRT has been shown to be more efficacious compared to placebo for the treatment of ISR in large randomized trials. However, even in patients treated with IRT, major adverse cardiac events occur in approximately 20% of cases on follow-up. This trial sought to elucidate the correlates of failure following successful IRT for ISR. To determine the correlates of IRT failure, we retrospectively compared the demographics, lesion characteristics, and clinical outcomes of 102 consecutive patients with ISR treated with Sr-90 from September 1998 to July 2001. IRT failure was defined as death, myocardial infarction (MI), or target vessel revascularization (TVR) due to repeat ISR on follow-up. A comparison of the clinical and angiographic profile of IRT failures (n = 16) vs. IRT successes (n = 86) revealed that a history of smoking (75% vs. 40%; P = 0.012), current use of calcium channel blockers (84% vs. 45%; P = 0.013), ostial location of target lesion (44% vs. 16%; P = 0.020), and mean posttreatment minimal luminal diameter (MLD; 1.64 +/- 0.19 vs. 2.21 +/- 0.29 mm; P < 0.001), respectively, were correlated with failure using univariate analysis. After multivariate regression analysis, the correlates of failure that remained significant were treatment of an ostial lesion (OR = 31.2; 95% CI = 2.6-382.7; P = 0.007) and final posttreatment MLD (P < 0.001). Ostial location of target lesion and smaller posttreatment MLD are correlated with subsequent death, MI, and TVR following therapy with Sr-90 for ISR.
authors.affiliation: Rush Heart Institute, Rush-Presbyterian-St. Luke's Medical Center and Rush Medical College, Chicago, Illinois 60612, USA. Falmeda@aol.com
authors.forename: Francis Q
authors.initials: FQ
authors.lastname: Almeda
authors.forename: David Y
authors.initials: DY
authors.lastname: Chua
authors.forename: Sandeep
authors.initials: S
authors.lastname: Nathan
authors.forename: Susie
authors.initials: S
authors.lastname: Kim
authors.forename: Peter M
authors.initials: PM
authors.lastname: Meyer
authors.forename: Cam
authors.initials: C
authors.lastname: Nguyen
authors.forename: James C H
authors.initials: JC
authors.lastname: Chu
authors.forename: Clifford J
authors.initials: CJ
authors.lastname: Kavinsky
authors.forename: R Jeffrey
authors.initials: RJ
authors.lastname: Snell
authors.forename: Gary L
authors.initials: GL
authors.lastname: Schaer
mesh_terms: D000368:Aged; D001610:Beta Particles / Q000627:therapeutic use; D019917:Blood Vessel Prosthesis Implantation; D001918:Brachytherapy; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000453:epidemiology / Q000601:surgery; D023903:Coronary Restenosis / Q000453:epidemiology / Q000209:etiology / Q000532:radiotherapy*; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013223:Statistics as Topic; D015607:Stents; D013326:Strontium Radioisotopes / Q000627:therapeutic use; D017211:Treatment Failure
chemical_list: D013326:Strontium Radioisotopes