Late target lesion revascularization after implantation of sirolimus-eluting stent.
OBJECTIVE
We evaluated the incidence, clinical presentation, and angiographic in-stent restenosis (ISR) pattern of late target lesion revascularization (TLR) after sirolimus-eluting stent (SES) implantation.


BACKGROUND
Late TLR is an unusual finding beyond 6-9 months after bare-metal stent implantation. However, late TLR after SES implantation has not been sufficiently evaluated.


METHODS
The study population consisted of 804 patients with 1,020 native lesions that were patent at 6-month follow-up angiogram after SES implantation.


RESULTS
Late TLR was performed in 18 patients with 18 lesions (1.8%) at 24.1 +/- 2.6 months (range; 18-30 months) after SES implantation. Clinical presentation of late TLR patients was silent ischemia in eight patients and recurrent angina in 10 patients, but none had an acute coronary syndrome. Angiographic ISR pattern of late TLR lesions were focal ISR in 12 lesions (67%) and diffuse ISR in six lesions (33%). Serial quantitative coronary angiographic analysis of these lesions showed a minimal lumen diameter of 2.6 +/- 0.5 mm immediately after SES implantation, 2.4 +/- 0.4 mm at 6-month follow-up and 0.7 +/- 0.6 mm at 24-month follow-up (ANOVA P < 0.001). By stepwise multiple logistic regression analysis, the only independent predictor of late TLR was stent length (P < 0.001, OR = 1.040, 95% CI = 1.019-1.061).


CONCLUSIONS
Late TLR was performed in 1.8% of 1,020 native lesions that were patent at 6-month follow-up angiogram. Clinical presentations of late TLR was either silent ischemia or recurrent angina, but not acute coronary syndrome. Two-thirds of late TLR lesions had a focal angiographic ISR pattern.
Hong
Myeong-Ki
MK
Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Mintz
Gary S
GS
Lee
Cheol Whan
CW
Park
Duk-Woo
DW
Lee
Seung-Whan
SW
Kim
Young-Hak
YH
Jung
In-Hyun
IH
Kim
Sang-Hyun
SH
Cheong
Sang-Sig
SS
Kim
Jae-Joong
JJ
Park
Seong-Wook
SW
Park
Seung-Jung
SJ
D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011336:Probability; D011475:Prosthesis Failure; D019233:Retreatment; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D020123:Sirolimus / Q000627:therapeutic use; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013997:Time Factors
D020123:Sirolimus