title: Repeated sirolimus-eluting stent implantation to treat sirolimus-eluting stent and bare-metal stent restenosis.
abstract: BACKGROUND
  In-stent restenosis (ISR) remains a persistent, unresolved issue even in the era of percutaneous coronary intervention (PCI) using drug-eluting stents. The present study compares the clinical and angiographic outcomes of using sirolimus-eluting stents (SES) for re-intervention against ISR that was originally treated with sirolimus-eluting or bare-metal (BMS) stents.
  
  
  RESULTS
  This prospective single-center registry investigated 179 ISR lesions in 158 consecutive patients (53 lesions in 49, and 126 in 109 patients originally treated with SES and BMS, respectively), who had undergone re-intervention with SES. The patients were clinically and angiographically followed up at 8 months after re-PCI. The incidence of re-restenosis (29 vs 12%, P<0.01), ischemia-driven target lesion revascularization (TLR; 21 vs 8%, P<0.05) and major adverse cardiac events (MACE; 21 vs 9%, P<0.05) were significantly greater in ISR lesions originally treated with SES than in those originally treated with BMS at 8 months after re-PCI. Moreover, late luminal loss was significantly greater in the group with post-SES restenosis (P<0.05). Even after adjustment, post-SES restenosis was the only independent predictor of re-restenosis and MACE (P<0.05, each).
  
  
  CONCLUSIONS
  Although the re-restenosis rate is acceptable, the incidence rates of late restenosis, ischemia-driven TLR and MACE are higher after repeated SES implantation to treat SES, than BMS restenosis. These results might affect the mid-term clinical outcomes of re-intervention with SES.
authors.affiliation: Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan. nishihira@fc.miyazaki-u.ac.jp
authors.forename: Kensaku
authors.initials: K
authors.lastname: Nishihira
authors.forename: Yoshisato
authors.initials: Y
authors.lastname: Shibata
authors.forename: Tetsunori
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Katsumasa
authors.initials: K
authors.lastname: Nomura
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Nakama
authors.forename: Daigo
authors.initials: D
authors.lastname: Mine
authors.forename: Yohei
authors.initials: Y
authors.lastname: Inoue
authors.forename: Keiichi
authors.initials: K
authors.lastname: Ashikaga
authors.forename: Nehiro
authors.initials: N
authors.lastname: Kuriyama
authors.forename: Akihiko
authors.initials: A
authors.lastname: Matsuyama
authors.forename: Takuroh
authors.initials: T
authors.lastname: Imamura
authors.forename: Yujiro
authors.initials: Y
authors.lastname: Asada
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kitamura
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D016017:Odds Ratio; D011446:Prospective Studies; D011474:Prosthesis Design; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D008670:Metals; D020123:Sirolimus