title: Myocardial infarction as a presentation of clinical in-stent restenosis.
abstract: BACKGROUND
  In-stent restenosis is considered to be a gradual and progressive condition and there is scant data on myocardial infarction (MI) as a clinical presentation.
  
  
  RESULTS
  Of 2,462 consecutive patients who underwent percutaneous coronary intervention between June 2001 and December 2002, clinical in-stent restenosis occurred in 212 (8.6%), who were classified into 3 groups: ST elevation MI (STEMI), non-ST elevation MI (NSTEMI) and non-MI. Of the 212 patients presenting with clinical in-stent restenosis, 22 (10.4%) had MI (creatine kinase (CK)>or=2xbaseline with elevated CKMB). The remaining 190 (89.6%) patients had stable angina or evidence of ischemia by stress test without elevation of cardiac enzymes. Median interval between previous intervention and presentation for clinical in-stent restenosis was shorter for patients with MI than for non-MI patients (STEMI, 90 days; NSTEMI, 79 days; non-MI, 125 days; p=0.07). Diffuse in-stent restenosis was more frequent in MI patients than in non-MI patients (72.7% vs 56.3%; p<0.005). Renal failure was more prevalent in patients with MI than in those without MI (31.8% vs 6.3%, p=0.001). Compared with the non-MI group, patients with MI were more likely to have acute coronary syndromes at the time of index procedure (81.8% vs 56.8%, p=0.02).
  
  
  CONCLUSIONS
  Clinical in-stent restenosis can frequently present as MI and such patients are more likely to have an aggressive angiographic pattern of restenosis. Renal failure and acute coronary syndromes at the initial procedure are associated with MI.
authors.affiliation: Department of Cardiovascular Medicine, Lahey Clinic Medical Center, Burlington, MA 01805, USA.
authors.forename: Atasu K
authors.initials: AK
authors.lastname: Nayak
authors.forename: Akio
authors.initials: A
authors.lastname: Kawamura
authors.forename: Richard W
authors.initials: RW
authors.lastname: Nesto
authors.forename: Gershan
authors.initials: G
authors.lastname: Davis
authors.forename: Jennifer
authors.initials: J
authors.lastname: Jarbeau
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Pyne
authors.forename: David E
authors.initials: DE
authors.lastname: Gossman
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Piemonte
authors.forename: Nabila
authors.initials: N
authors.lastname: Riskalla
authors.forename: Manish S
authors.initials: MS
authors.lastname: Chauhan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D023903:Coronary Restenosis / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D018450:Disease Progression; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D051437:Renal Insufficiency / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D015607:Stents
chemical_list: D010975:Platelet Aggregation Inhibitors