title: Repeat drug-eluting stent implantation for in-stent restenosis: first- or second-generation stent.
abstract: OBJECTIVE
  To investigate the efficacy and safety of a second-generation drug-eluting stent (DES) for in-stent restenosis (ISR) after first-generation DES implantation.
  
  
  BACKGROUND
  The everolimus-eluting stent is a second-generation DES that is very effective for de novo coronary lesions.
  
  
  METHODS
  The subjects were 145 consecutive patients who underwent re-stenting, including 93 given a first-generation DES and 52 given a second-generation DES. The two groups were followed up for 37.8 ± 16.7 months and 13.8 ± 2.1 months, respectively. The primary endpoint was in-stent late luminal loss at 8-month angiographic follow-up.
  
  
  RESULTS
  Baseline clinical and angiographic parameters were similar in the 2 groups. Follow-up angiography showed that late luminal loss (0.26 ± 0.31 mm vs 0.58 ± 0.67 mm; P=.01), the binary restenosis rate (2.6% vs 16.7%; P=.03), and the target lesion revascularization (TLR) rate (1.9% vs 11.8%; log-rank = 0.04) were smaller in the second-generation group than in the first-generation group. There was no definite stent thrombosis in either group. During follow-up, there were no significant between-group differences of major adverse cardiac events without TLR, myocardial infarction, death, and death + myocardial infarction. Multivariate analysis demonstrated that using a first-generation DES was the only independent predictor of TLR after 1 year (odds ratio, 2.78; 95% confidence interval, 1.22-5.43; P=.03).
  
  
  CONCLUSIONS
  When ISR occurs after DES implantation, treatment with a second-generation DES reduces late luminal loss, binary restenosis, and TLR after 1 year compared with a first-generation DES.
authors.affiliation: Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Yokohama, Japan. kennosuke.atmm3@gmail.com
authors.forename: Kennosuke
authors.initials: K
authors.lastname: Yamashita
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ochiai
authors.forename: Tadayuki
authors.initials: T
authors.lastname: Yakushiji
authors.forename: Seitarou
authors.initials: S
authors.lastname: Ebara
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Okabe
authors.forename: Myong Hwa
authors.initials: MH
authors.lastname: Yamamoto
authors.forename: Shigeo
authors.initials: S
authors.lastname: Saito
authors.forename: Koichi
authors.initials: K
authors.lastname: Hoshimoto
authors.forename: Naoei
authors.initials: N
authors.lastname: Isomura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Araki
authors.forename: Chiaki
authors.initials: C
authors.lastname: Obara
mesh_terms: D000328:Adult; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation* / Q000379:methods*; D012189:Retrospective Studies; D020123:Sirolimus / Q000031:analogs & derivatives
chemical_list: D000068338:Everolimus; D020123:Sirolimus