Repeat percutaneous coronary revascularization: indications and outcomes in a "real world" cohort.
OBJECTIVE
To investigate rates of and reasons for second and subsequent stent procedures in an unselected, "real-world" population.


BACKGROUND
Repeat stenting is the primary difference reported in clinical trials of alternative revascularization strategies. The incidence, indication, and outcome for repeat stenting in contemporary practice outside the more selective populations of trials and registries has not been described.


METHODS
All patients undergoing a first percutaneous coronary intervention (PCI) procedure with stenting from January 2001 to August 2009 (10,509) from a large UK tertiary referral and district general hospital were identified. Mortality and the incidence, timing, and indication for repeat revascularization in this population were investigated from patient records.


RESULTS
Of 10,509 patients undergoing a first PCI and stent implant 23.5% underwent repeat angiography of which 11.2% required repeat PCI and 2% coronary artery bypass grafting (median follow-up of 3.8 years). A total of 1.3% went on to a third PCI. The commonest indication for repeat stenting was disease progression remote from the original stent (46%) and planned staged PCI (23%); 21% had a stent-related indication. Functional assessment before repeat stenting was used in one-third of stable patients. Mortality was 2.5% per annum.


CONCLUSIONS
In contemporary practice, patients undergoing a first stenting procedure have a low subsequent mortality, and the substantial majority (86.4%) requires no further revascularization over a median 3.8 year follow-up. For those who do require repeat stenting, this is most commonly at a site remote from the first stent.
Oxford Heart Centre, Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom. dadlam@well.ox.ac.uk.
David
D
Adlam
Nicholas
N
Evans
Aneil
A
Malhotra
Disha
D
Midha
Felicity
F
Rowley
David
D
Hutchings
Mirae
M
Shin
Guy
G
Mole
Alexander
A
Stockenhuber
Mark
M
Lumb
Jonathan
J
Wordsworth
Sophie
S
Frantal
J Colin
JC
Forfar
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D023903:Coronary Restenosis / Q000209:etiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D018450:Disease Progression; D004739:England; D005260:Female; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D016016:Proportional Hazards Models; D019233:Retreatment; D015607:Stents; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome