title: Long-term follow-up of patients with sirolimus-eluting stents for treatment of bare-metal in-stent restenosis.
abstract: BACKGROUND
  Limited data is available on the long-term outcome after sirolimus-eluting stent (SES) implantation for in-stent restenosis.
  
  
  METHODS
  In 3 centers, consecutive patients (n=100) with percutaneous coronary intervention (PCI) for in-stent restenosis (n=110) were treated with SES: 28 lesions were focal, 40 diffuse, 17 proliferative, and 15 totally occluded (reference vessel diameter: 3.0+/-0.2 mm, lesion length: 13.8+/-5.7 mm).
  
  
  RESULTS
  SES implantation was successful in all patients. The mean follow-up was 50+/-12 months. The main univariate predictive factor of definite (4%) or probable (4%) SES thrombosis was revascularization without SES in a non-target site during the initial procedure (p<0.01). Repeated target lesion revascularization (TLR) was performed in 8 patients (8%) at 1 year, in 10 patients (10%) at 4 years. A cardiac event related to the SES occurred in 14 patients (14%) at one year, 17 patients (17%) at 4 years, and were associated with unstable angina (p<0.05), multivessel disease (p<0.02) and revascularization without SES in another site of the target vessel during the initial procedure (p<0.01).
  
  
  CONCLUSIONS
  SESs are effective at 4 years in the treatment of high risk patients with complex in-stent restenosis, with a low risk of TLR but a high risk of stent thrombosis. Most of cardiac events related to the target vessel occur during the first year, and are associated to a revascularization without SES in another site during the first procedure.
authors.affiliation: Cardiology Department, Pitié-Salpêtrière Hospital, 47 et 83 Bd de l'Hôpital, 75651 Paris cedex 13, France. claude.lefeuvre@psl.ap-hop-paris.fr
authors.forename: Claude
authors.initials: C
authors.lastname: Le Feuvre
authors.forename: Aude
authors.initials: A
authors.lastname: Healy-Brucker
authors.forename: Gérard
authors.initials: G
authors.lastname: Helft
authors.forename: Jacques
authors.initials: J
authors.lastname: Monségu
authors.forename: Olivier
authors.initials: O
authors.lastname: Varenne
authors.forename: Christian
authors.initials: C
authors.lastname: Spaulding
authors.forename: Jean P
authors.initials: JP
authors.lastname: Collet
authors.forename: Farzin
authors.initials: F
authors.lastname: Beygui
authors.forename: Olivier
authors.initials: O
authors.lastname: Barthélémy
authors.forename: Rémi
authors.initials: R
authors.lastname: Choussat
authors.forename: Gilles
authors.initials: G
authors.lastname: Montalescot
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Metzger
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000453:epidemiology / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000628:therapy*; D023903:Coronary Restenosis / Q000453:epidemiology*; D003328:Coronary Thrombosis / Q000453:epidemiology; D054855:Drug-Eluting Stents / Q000009:adverse effects* / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008670:Metals; D008875:Middle Aged; D011237:Predictive Value of Tests; D012042:Registries; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage*; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents; D008670:Metals; D020123:Sirolimus