title: Impact of in-stent restenosis on death and myocardial infarction.
abstract: Although drug-eluting stents reduce restenosis and target lesion revascularization compared with bare metal stents (BMSs), the specter of late stent thrombosis has curbed enthusiasm for the widespread use of drug-eluting stents. Alternatively, increasing BMS use would increase restenosis and potentially increase adverse events. The presentation and outcomes of BMS restenosis are controversial. We evaluated 2,539 patients with BMS restenosis referred for repeat revascularization. Major adverse cardiac events, including mortality and myocardial infarction (MI), were assessed at clinical presentation, 30 days, and 6 months. Patients with acute presentation (i.e., unstable angina requiring hospitalization or MI) were compared with patients with stable presentation. At presentation, 19.2% of patients were asymptomatic, 27.5% had exertional angina, 46.6% had unstable angina, and 6.7% had MI. Mortality and MI rates were 1.1% and 1.4%, respectively, at 30 days and 3.3% and 4.5%, respectively, at 6 months. Patients with acute coronary syndrome (ACS) and those without ACS had similarly low mortality rates at 30 days (1.2% ACS vs 1.0% non-ACS, p = 0.65) and 6 months (3.4% ACS vs 3.3% non-ACS, p = 0.93) and MI rates at 30 days (1.3% ACS vs 1.4% non-ACS, p = 0.87) and 6 months (4.7% ACS vs 4.3% non-ACS, p = 0.65). Combined major adverse cardiac events were similar at 30 days (2.5% vs 2.1%, p = 0.53) and 6 months (7.4% ACS vs 6.9%, non-ACS, p = 0.65). In conclusion, although BMS restenosis often manifests as an ACS, it is associated with a low incidence of 6-month major adverse cardiac events and does not predict a negative outcome.
authors: Division of Cardiology, Washington Hospital Center, Washington, DC, USA.
authors: Daniel H
authors: DH
authors: Steinberg
authors: Tina L
authors: TL
authors: Pinto Slottow
authors: Ashesh N
authors: AN
authors: Buch
authors: Aamir
authors: A
authors: Javaid
authors: Probal K
authors: PK
authors: Roy
authors: Shaila
authors: S
authors: Garg
authors: Teruo
authors: T
authors: Okabe
authors: Rebecca
authors: R
authors: Torguson
authors: Kimberly A
authors: KA
authors: Smith
authors: Zhenyi
authors: Z
authors: Xue
authors: William O
authors: WO
authors: Suddath
authors: Kenneth M
authors: KM
authors: Kent
authors: Lowell F
authors: LF
authors: Satler
authors: Augusto D
authors: AD
authors: Pichard
authors: Joseph
authors: J
authors: Lindsay
authors: Ron
authors: R
authors: Waksman
mesh_terms: D000789:Angina, Unstable / Q000209:etiology*; D023903:Coronary Restenosis / Q000150:complications* / Q000453:epidemiology* / Q000601:surgery; D003328:Coronary Thrombosis / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology*; D009204:Myocardial Revascularization; D011446:Prospective Studies; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors