title: Very long-term (15 to 20 years) clinical and angiographic outcome after coronary bare metal stent implantation.
abstract: BACKGROUND
  We previously reported that the long-term luminal response after coronary bare metal stenting is triphasic, with an early restenosis phase spanning the 6 months after the index procedure, an intermediate-term regression phase from 6 months to 3 years, and a late renarrowing phase beyond 4 years. However, the clinical significance of late luminal renarrowing remains unknown.
  
  
  RESULTS
  Angiographic and clinical follow-up of the same cohort of 405 patients with successful Palmaz-Schatz stent placement was extended beyond 15 years. Clinical follow-up was completed in 98% of patients at 5 years and in 81% at 15 years. The incidence of death and cardiac death at 15 years was 45.4% and 20.6%, respectively. Paired long-term (4 to 10 years) and very long-term (>10 years) angiographic studies without intercurrent target lesion revascularization were performed in 55 lesions, and minimal luminal diameter further decreased from 1.88±0.50 mm to 1.60±0.73 mm (P=0.002). Late target lesion revascularization after initial stabilization of the stented segments occurred rarely within 4 years. Beyond 4 years, however, the incidence of late target lesion revascularization increased steadily from 3.3% at 4 years to 24.7% at 15 years. The incidence of definite very late stent thrombosis was low (1.5% at 15 years).
  
  
  CONCLUSIONS
  Luminal renarrowing of the stented segment beyond 4 years was a progressive process extending beyond 10 years. The angiographic observation of late in-stent restenosis was clinically relevant because a corresponding progressive increase in the incidence of late target lesion revascularization was observed beyond 4 years and up to 15 to 20 years after bare metal stent implantation.
authors.affiliation: Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Kyohei
authors.initials: K
authors.lastname: Yamaji
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nakagawa
authors.forename: Katsumi
authors.initials: K
authors.lastname: Inoue
authors.forename: Yoshimitsu
authors.initials: Y
authors.lastname: Soga
authors.forename: Takeshi
authors.initials: T
authors.lastname: Arita
authors.forename: Shinichi
authors.initials: S
authors.lastname: Shirai
authors.forename: Kenji
authors.initials: K
authors.lastname: Ando
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Kondo
authors.forename: Koyu
authors.initials: K
authors.lastname: Sakai
authors.forename: Masahiko
authors.initials: M
authors.lastname: Goya
authors.forename: Masashi
authors.initials: M
authors.lastname: Iwabuchi
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Yokoi
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Nosaka
authors.forename: Masakiyo
authors.initials: M
authors.lastname: Nobuyoshi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D023903:Coronary Restenosis / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects* / Q000706:statistics & numerical data; D016019:Survival Analysis; D013927:Thrombosis / Q000209:etiology*; D013997:Time Factors