Long-term clinical outcome of alternative treatment strategies for drug-eluting stents restenosis.
OBJECTIVE
Due to the widespread use of drug-eluting stents (DES), in-DES restenosis is increasing. The aim of this study is to evaluate the clinical outcome of patients undergoing repeat percutaneous coronary intervention (PCI) for DES restenosis.


RESULTS
One hundred patients with 108 restenotic lesions using DES were consecutively enrolled in a single-arm 2-centre registry. The repeat-PCI was performed either with balloon angioplasty (POBA) or with DES implantation (homo-stent or hetero-stent). Major adverse cardiac events (MACE) occurrence was assessed long-term. Of the 108 DES restenotic lesions, 34 were treated with balloon angioplasty, 43 with homo-stent and 31 with hetero-stent implantation. Of the patients, 37% had diabetes mellitus, while 30% peripheral or carotid artery disease. Over a mean follow-up of 16.0+/-6.0 months, the rates of death, myocardial infarction (MI), and ischaemic driven target lesion revascularisation (IDTLR) in hetero-stent, homo-stent and POBA groups were respectively 0% vs. 5% vs. 3% (p=NS), 2% vs. 5% vs. 0% (p=NS) and 17% vs. 23% vs. 25% (p=NS). When comparing patients treated with POBA to those receiving hetero-/homo-DES, no significant difference in terms of IDTLR (25% vs. 20%; p=NS), MI (0% vs. 4%; p=NS) and overall MACE (25% vs. 23%, p=NS) appeared. The presence of previous MI (OR 0.05; 95% CI 0.01-0.3), first DES implanted for BMS restenosis (OR 0.16; 95% CI 0.02-0.99) and peripheral or carotid disease (OR 0.09; 95% CI 0.01-0.67) were negative independent predictors of freedom from IDTLR.


CONCLUSIONS
Repeat balloon angioplasty for DES restenosis showed similar clinical outcome compared to re-DES (homo- or hetero-) implantation and could be considered as first treatment strategy in this setting.
Liistro
Francesco
F
San Donato Hospital, Arezzo, Italy.
Fineschi
Massimo
M
Grotti
Simone
S
Angioli
Paolo
P
Carrera
Arcangelo
A
Ducci
Kenneth
K
Gori
Tommaso
T
Falsini
Giovanni
G
Pierli
Carlo
C
Bolognese
Leonardo
L
D000368:Aged; D023903:Coronary Restenosis / Q000453:epidemiology*; D003331:Coronary Vessels / Q000473:pathology; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality; D019919:Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D012042:Registries; D016019:Survival Analysis; D017741:Survivors; D013997:Time Factors; D014664:Vasodilation / Q000502:physiology
D006493:Heparin