Predictive factors of re-restenosis after repeated sirolimus-eluting stent implantation for SES restenosis and clinical outcomes after percutaneous coronary intervention for SES restenosis.
Sirolimus-eluting stent (SES) is established to be effective in reducing restenosis. Repeat revascularization, however, is still required in up to 5-8% of patients. In this study, we analyzed clinical and angiographic variables that might be related with SES re-restenosis and variables related with re-restenosis after repeat SES implantation for SES restenosis. We also assessed clinical outcomes at 2-year follow-up after percutaneous coronary intervention (PCI) for SES restenosis. Repeat revascularization for SES restenosis was performed in 113 patients with 140 lesions. Of the 140 lesions, follow-up coronary angiography (CAG) was performed on 117 lesions (101 patients) and revealed 46 SES re-restenotic and 71 non-re-restenotic lesions. In multivariate analysis, SES-in-SES-strategy and reference diameter before the second PCI were independent predictors of re-restenosis after PCI for SES restenosis. However, the reference diameter was the only independent predictor of re-restenosis after SES-in-SES. Major adverse cardiac events (MACE) at 2 years were found in 44 patients (43.5%), and target lesion revascularization (TLR) was performed in 33.7% of patients after SES restenosis. In conclusion, the incidence of MACE and TLR was relatively high in patients with SES restenosis, but the placement of another SES on larger-diameter vessels may be an effective strategy for the second PCI.
Chatani
Kenichi
K
Department of Cardiology, Saiseikai Toyama Hospital, Toyama, Japan. chatani5028@r8.dion.ne.jp
Muramatsu
Toshiya
T
Tsukahara
Reiko
R
Ito
Yoshiaki
Y
Ishimori
Hiroshi
H
Hirano
Keisuke
K
Nakano
Masatsugu
M
Yamawaki
Masahiro
M
Araki
Motoharu
M
Sakurai
Masayuki
M
Iuchi
Kazuyuki
K
Nozawa
Takashi
T
Inoue
Hiroshi
H
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D016001:Confidence Intervals; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000209:etiology* / Q000517:prevention & control; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D020123:Sirolimus / Q000627:therapeutic use*; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D020123:Sirolimus