Long-term outcomes after management of restenosis or thrombosis of drug-eluting stents.
OBJECTIVE
The purpose of this study was to examine the outcomes of patients who developed coronary in-stent restenosis (ISR) or stent thrombosis (STH) inside drug-eluting stents (DES).


BACKGROUND
Drug-eluting stents have markedly reduced the incidence of restenosis. However, when restenosis occurs within a DES, its optimal management remains unclear.


METHODS
We retrospectively analyzed clinical and angiographic data from 92 patients who underwent revascularization for ISR (n = 84) or STH (n = 8) within a DES at our institution. Regular follow-ups were available up to 2 years. We recorded the occurrence of major adverse cardiac events (MACE), defined as deaths from all causes, myocardial infarction (MI), or target lesion revascularization (TLR), among patients treated by the "DES sandwich" technique or by other treatment methods.


RESULTS
In-hospital MACE included 1 periprocedural MI and 2 deaths. Over a mean follow-up of 15 +/- 6 months, the overall rates of death, MI, and TLR were 8.7%, 2.2%, and 30.6%, respectively. By actuarial analysis, the 12-month TLR and MACE rates were 28.2% and 42.9%, respectively.


CONCLUSIONS
Current treatments of ISR or STH in DES are associated with a high long-term rate of MACE.
Mishkel
Gregory J
GJ
Prairie Heart Institute at St. John's Hospital, Springfield, Illinois 62794, USA.
Moore
Anna L
AL
Markwell
Steve
S
Shelton
M Coleman
MC
Shelton
Marc E
ME
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D002423:Cause of Death; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality* / Q000628:therapy; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016503:Drug Delivery Systems; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D011379:Prognosis; D019233:Retreatment; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D020123:Sirolimus / Q000494:pharmacology; D015607:Stents / Q000009:adverse effects*; D015996:Survival Rate
D020123:Sirolimus