title: Incidence and predictors of the late catch-up phenomenon after drug-eluting stent implantation.
abstract: BACKGROUND
  Although clinical restenosis within 1 year after percutaneous coronary intervention has been remarkably reduced with the advent of drug-eluting stents (DES), the late catch-up (LCU) phenomenon remains an issue despite medical advances. The aim of this study was to investigate the incidence and predictive factors of the LCU phenomenon in an unselected population treated with first-generation DES.
  
  
  METHODS
  A total of 923 patients treated with DES between June 2004 and August 2008 were analyzed. The LCU phenomenon was defined as secondary revascularization 1 year after index stenting. Retreatment for very late stent thrombosis was considered as part of the LCU phenomenon.
  
  
  RESULTS
  Incidence of the LCU phenomenon was seen in 33 patients (3.6%). Very late stent thrombosis was observed in 5 patients (0.6%) and very late in-stent restenosis was observed in 28 patients (3.0%). At the 12-month landmark analysis, the cumulative rate of cardiac death was significantly higher in patients with the LCU phenomenon than in those without any target lesion revascularization (9.0% vs. 0.9%, p<0.001). In the multivariate analysis, hemodialysis [odds ratio (OR) 6.07, p=0.003], number of stents (OR 1.58, p=0.02), and coronary bifurcation lesions (OR 2.06, p=0.048) were identified as independent predictors of the LCU phenomenon.
  
  
  CONCLUSIONS
  The LCU phenomenon is associated with serious consequences and adverse events and remains an important issue in modern practice, despite medical advances. DES should be deployed with a minimum number of stents, and special consideration must be given to patients on hemodialysis and those with coronary bifurcation lesions.
authors.affiliation: Division of Cardiovascular Medicine, Ohashi hospital, Toho University Medical Center, Japan. Electronic address: raisuke@live.jp.
authors.forename: Raisuke
authors.initials: R
authors.lastname: Iijima
authors.forename: Tadashi
authors.initials: T
authors.lastname: Araki
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Nagashima
authors.forename: Kenji
authors.initials: K
authors.lastname: Yamazaki
authors.forename: Makoto
authors.initials: M
authors.lastname: Utsunomiya
authors.forename: Masaki
authors.initials: M
authors.lastname: Hori
authors.forename: Hideki
authors.initials: H
authors.lastname: Itaya
authors.forename: Hideo
authors.initials: H
authors.lastname: Shinji
authors.forename: Masanori
authors.initials: M
authors.lastname: Shiba
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Hara
authors.forename: Masato
authors.initials: M
authors.lastname: Nakamura
authors.forename: Kaoru
authors.initials: K
authors.lastname: Sugi
mesh_terms: D000368:Aged; D023903:Coronary Restenosis / Q000453:epidemiology*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D019233:Retreatment; D013927:Thrombosis / Q000453:epidemiology* / Q000209:etiology*; D013997:Time Factors
keywords: Drug-eluting stent; Late catch-up phenomenon; Late in-stent restenosis; Percutaneous coronary intervention; Very late stent thrombosis