title: Clinical impact of angiographic restenosis after bare-metal stent implantation on long-term outcomes in patients with coronary artery disease.
abstract: BACKGROUND
  In-stent restenosis (ISR) after bare-metal stent (BMS) implantation is thought to be clinically benign, although this notion remains controversial. The long-term clinical outcomes of ISR with BMS have not been established.
  
  
  RESULTS
  Among 983 consecutive patients (1,227 lesions) implanted with a BMS between 1999 and 2004 at the authors' institution, 746 underwent routine follow-up angiography. Angiographic ISR (ISR group) was evident in 215 patients (28.8%) and 136 of them underwent repeat revascularization. The incidence of major adverse cardiac events (MACE), acute coronary syndrome (ACS), target lesion revascularization and all-cause death were evaluated between patients with and without ISR (non-ISR group). Patients in the ISR group were older and more likely to have diabetes. The median follow-up period was 2,031 days. The rates of MACE and ACS were significantly higher in the ISR group compared with the non-ISR group (33.5% vs. 13.7%, P<0.0001 and 11.2% vs. 7.0%, P<0.05, respectively). Multivariate Cox regression analysis demonstrated that ISR was significantly associated with clinical outcomes (adjusted hazard ratio [HR] for MACE, 2.81; 95% confidence interval [CI]: 2.01-3.94, P<0.01; adjusted HR for ACS, 1.84; 95%CI: 1.08-3.13, P<0.05).
  
  
  CONCLUSIONS
  ISR with BMS was significantly associated with long-term adverse clinical outcomes. Risk of future cardiovascular events due to ISR must be carefully considered.
authors.affiliation: Department of Cardiovascular Medicine, Juntendo University, Tokyo, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Ogita
authors.forename: Katsumi
authors.initials: K
authors.lastname: Miyauchi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kurata
authors.forename: Ken
authors.initials: K
authors.lastname: Yokoyama
authors.forename: Tomotaka
authors.initials: T
authors.lastname: Dohi
authors.forename: Shuta
authors.initials: S
authors.lastname: Tuboi
authors.forename: Tadashi
authors.initials: T
authors.lastname: Miyazaki
authors.forename: Akihisa
authors.initials: A
authors.lastname: Nishino
authors.forename: Takayuki
authors.initials: T
authors.lastname: Yokoyama
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Daida
mesh_terms: D054058:Acute Coronary Syndrome / Q000209:etiology / Q000401:mortality; D000367:Age Factors; D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000401:mortality* / Q000601:surgery*; D003920:Diabetes Mellitus / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate