title: Clinical presentation and predictors of target vessel revascularization after drug-eluting stent implantation.
abstract: BACKGROUND
  Drug eluting stent (DES) failure including restenosis and stent thrombosis, or disease progression may result in target vessel revascularization (TVR) but the relative contribution of these mechanisms in the DES era is not well described. We sought to examine the predictors and presentations of patients with clinically driven TVR after DES.
  
  
  METHODS
  Patients with all lesions treated with a DES in the Dynamic Registry from 2004 to 2006 were analyzed. Included were 2691 patients with 3401 lesions. Patients with and without incident clinically driven TVR at 2years were compared according to baseline clinical, procedural, and angiographic characteristics and independent predictors of TVR and target lesion revascularization (TLR) were determined by multivariate analysis.
  
  
  RESULTS
  By 2-years, TVR occurred in 7.2% of patients and TLR in 3.8%, with 71.6% and 82.5% of repeat revascularization events occurring in the first year, respectively. The indication for first TVR was myocardial infarction in 18.6% (n=34), unstable angina in 42.6% (n=78), stable coronary disease in 25.7% (n=47) and other/unknown in 13.1% (n=24). Disease progression was responsible for 47% of TVR. Among patients with TLR, restenosis was the mechanism in 86.6% and stent thrombosis in 13.4%. Independent predictors of TVR included younger age, diabetes, attempted graft lesion, lesion length >30mm and prior lesion intervention. Independent predictors of TVR and TLR were similar.
  
  
  CONCLUSIONS
  The incidence of clinically driven TVR is low in patients treated with DES and nearly half is attributable to disease progression, which along with the low rate of in-stent restenosis explains why the mode of presentation is often an acute coronary syndrome.
authors.affiliation: Division of Cardiology, Rhode Island Hospital, Brown University, 593 Eddy St, Providence, RI 02903, USA.
authors.forename: Hazem
authors.initials: H
authors.lastname: Al Muradi
authors.forename: Aditya
authors.initials: A
authors.lastname: Mehra
authors.forename: Joseph
authors.initials: J
authors.lastname: Okolo
authors.forename: Helen
authors.initials: H
authors.lastname: Vlachos
authors.forename: Faith
authors.initials: F
authors.lastname: Selzer
authors.forename: Oscar C
authors.initials: OC
authors.lastname: Marroquin
authors.forename: Kimberly
authors.initials: K
authors.lastname: Skelding
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Holper
authors.forename: David O
authors.initials: DO
authors.lastname: Williams
authors.forename: J Dawn
authors.initials: JD
authors.lastname: Abbott
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000379:methods; D023903:Coronary Restenosis / Q000453:epidemiology*; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome