Very long-term (15 to 20 years) clinical and angiographic outcome after coronary bare metal stent implantation.
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.
Yamaji
Kyohei
K
Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
Kimura
Takeshi
T
Morimoto
Takeshi
T
Nakagawa
Yoshihisa
Y
Inoue
Katsumi
K
Soga
Yoshimitsu
Y
Arita
Takeshi
T
Shirai
Shinichi
S
Ando
Kenji
K
Kondo
Katsuhiro
K
Sakai
Koyu
K
Goya
Masahiko
M
Iwabuchi
Masashi
M
Yokoi
Hiroyoshi
H
Nosaka
Hideyuki
H
Nobuyoshi
Masakiyo
M
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