title: Incidence of definite stent thrombosis or in-stent restenosis after drug-eluting stent implantation for treatment of coronary in-stent restenosis: from Western Denmark Heart Registry.
abstract: BACKGROUND
  There are limited data on the optimal management of in-stent restenosis after percutaneous coronary intervention (PCI) with bare metal stent (BMS) or drug-eluting stent (DES) implantations. We assessed the clinical presentation, the incidence, and prognosis of definite stent thrombosis or restenosis after DES implantation for treatment of restenosis.
  
  
  METHODS
  From January 2002 to June 2005, all consecutive patients with restenosis < 12 months after index PCI with DES or BMS implantation, were identified in the population-based Western Denmark Heart Registry. Patients were followed until 24 months after their first restenosis.
  
  
  RESULTS
  A total of 589 lesions were treated for clinically driven restenosis with target lesion revascularization (TLR) within 12 months after the index PCI. Among those, 302 lesions were treated with DES (BMS-restenosis n = 244 and DES-restenosis n = 58). Admission were due to stable angina pectoris (n = 249 (82.4%)), unstable angina pectoris (n = 34 (11.3%)), or non-ST segment elevation myocardial infarction (n = 19 (6.3%)). The clinical indication was not different between patients with BMS restenosis compared to DES restenosis. In the BMS restenosis group, older age, longer lesion, longer stent length, and a higher number of stents used was observed compared to the DES restenosis group. After a first restenosis, clinically driven re-TLR was seen in 26 (8.6%) patients within the following 24 months, stent thrombosis (median duration 155 days, interquartile range (IQR) 9-627 days) was seen in 3 lesions (1.0%), and secondary restenosis (median duration 168 days, IQR 88-266 days) was seen in 23 (7.6%) [DES restenosis group 6.9% vs. BMS restenosis group 7.8%, P = 0.818] lesions.
  
  
  CONCLUSIONS
  The clinical presentation did not differ between BMS or DES and most patients present with stable angina pectoris. Risk of stent thrombosis or restenosis was not increased in patients with DES restenosis compared to patients with BMS restenosis treated with DES.
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark. jesperkjensen@dadlnet.dk
authors.forename: Jesper Khedri
authors.initials: JK
authors.lastname: Jensen
authors.forename: Lisette Okkels
authors.initials: LO
authors.lastname: Jensen
authors.forename: Christian Juhl
authors.initials: CJ
authors.lastname: Terkelsen
authors.forename: Jens Flensted
authors.initials: JF
authors.lastname: Lassen
authors.forename: Hans Henrik
authors.initials: HH
authors.lastname: Tilsted
authors.forename: Knud Noerregaard
authors.initials: KN
authors.lastname: Hansen
authors.forename: Michael
authors.initials: M
authors.lastname: Maeng
authors.forename: Leif
authors.initials: L
authors.lastname: Thuesen
authors.forename: Per
authors.initials: P
authors.lastname: Thayssen
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000453:epidemiology / Q000628:therapy; D023903:Coronary Restenosis / Q000453:epidemiology / Q000628:therapy*; D003718:Denmark / Q000453:epidemiology; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D011474:Prosthesis Design; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D013927:Thrombosis / Q000453:epidemiology*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008670:Metals