title: Early- and medium-term outcomes after paclitaxel-eluting stent implantation for sirolimus-eluting stent failure.
abstract: The optimal treatment for sirolimus-eluting stent (SES) restenosis is not known. This study evaluated the safety and clinical outcome of paclitaxel-eluting stent (PES) implantation for SES restenosis. From March 2004 to July 2005, PESs were implanted in 125 patients with 140 lesions with SES restenosis. Acute and 6-month clinical outcomes were determined through review of the medical record and/or telephone interview. In-hospital major adverse cardiac events (death, nonfatal myocardial infarction, or repeat revascularization) occurred in 14 patients (11.2%), driven entirely by postprocedure non-Q-wave myocardial infarction. At a mean clinical follow-up of 7.2 +/- 1.8 months, the incidence of target lesion revascularization (TLR) was 14.0%, and the rate of major adverse cardiac events was 17.2%. Subacute thrombosis occurred in 2 patients (1.6%). Length of PES implanted, postprocedure diameter stenosis, and total occlusion of the target lesion were independent predictors of TLR. In patients with de novo SES restenosis, TLR was only 8.7%. In conclusion, at medium-term follow-up, PES implantation for SES failure appears to be safe and effective, although efficacy is decreased in the setting of total occlusions, greater residual diameter stenosis, and longer PESs.
authors.affiliation: Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, California, USA. lee.steve@gmail.com
authors.forename: Steve S
authors.initials: SS
authors.lastname: Lee
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Price
authors.forename: Garrett B
authors.initials: GB
authors.lastname: Wong
authors.forename: Rafael
authors.initials: R
authors.lastname: Valencia
authors.forename: Samir
authors.initials: S
authors.lastname: Damani
authors.forename: Neil
authors.initials: N
authors.lastname: Sawhney
authors.forename: Raghava R
authors.initials: RR
authors.lastname: Gollapudi
authors.forename: Richard A
authors.initials: RA
authors.lastname: Schatz
authors.forename: Paul S
authors.initials: PS
authors.lastname: Teirstein
mesh_terms: D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D015897:Comorbidity; D023903:Coronary Restenosis / Q000188:drug therapy*; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D017239:Paclitaxel / Q000627:therapeutic use*; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use*; D015607:Stents; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D017239:Paclitaxel; D020123:Sirolimus