title: Long-term clinical outcomes after intravascular brachytherapy for instent restenosis and de novo coronary artery lesions in percutaneous coronary intervention.
abstract: BACKGROUND
  We examined the long term clinical outcomes after administration of intravascular brachytherapy (IVBT) for instent restenosis (ISR) and de novo coronary artery lesions in percutaneous coronary intervention (PCI).
  
  
  METHODS
  From May 2000 to August 2004, 129 symptomatic patients with ISR and de novo coronary artery lesions were treated with intravascular beta radiation after successful PCI. The primary end-point was major adverse cardiac event (MACE), i.e., a composite of all-cause death, myocardial infarction and target lesion revascularization (TLR) within 5 years of follow-up.
  
  
  RESULTS
  The mean age of patients was 64+10 years with a male predominance (78%). The majority of patients had diffuse bare metal instent restenotic lesions and 19 patients (15%) had de novo coronary artery lesions. From hospital discharge to follow-up at 5 years (mean follow-up period 75.3+17.7 months), the annual consecutive MACE rates were 16.3%, 13.4%, 8%, 12.2% and 6.6% respectively and were mainly driven by the need for TLR. Left anterior descending artery (LAD) as target vessel of PCI was an independent predictor of long term MACE (OR: 3.5; 95% confidence interval:1.2-10.6; P=.03). There were six cases of stent thrombosis (cumulative incidence of 4.7%) with case fatality rate of 33% (2/6).
  
  
  CONCLUSIONS
  MACE rates remained high post IVBT at 5 years of follow-up and were mainly driven by the need for TLR. LAD as target vessel of PCI was an independent predictor of long term MACE.
authors.affiliation: Cardiac Medical Unit, Grantham Hospital, Hong Kong. Electronic address: hokai_wah@yahoo.com.
authors.forename: Hee Hwa
authors.initials: HH
authors.lastname: Ho
authors.affiliation: Cardiac Medical Unit, Grantham Hospital, Hong Kong.
authors.forename: On Hing
authors.initials: OH
authors.lastname: Kwok
authors.affiliation: Cardiac Medical Unit, Grantham Hospital, Hong Kong.
authors.forename: Man Hong
authors.initials: MH
authors.lastname: Jim
authors.affiliation: Cardiac Medical Unit, Grantham Hospital, Hong Kong.
authors.forename: Chung Wah
authors.initials: CW
authors.lastname: Siu
authors.affiliation: Cardiac Medical Unit, Grantham Hospital, Hong Kong.
authors.forename: Vincent
authors.initials: V
authors.lastname: Pong
authors.affiliation: Cardiac Medical Unit, Grantham Hospital, Hong Kong.
authors.forename: Wing Hing
authors.initials: WH
authors.lastname: Chow
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D001918:Brachytherapy / Q000009:adverse effects; D023903:Coronary Restenosis / Q000209:etiology / Q000401:mortality / Q000532:radiotherapy*; D023921:Coronary Stenosis / Q000532:radiotherapy / Q000628:therapy*; D005260:Female; D006723:Hong Kong; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome