title: Temporal patterns of drug-eluting stent failure and its relationship with clinical outcomes.
abstract: OBJECTIVE
  We investigated the temporal patterns of drug-eluting stents (DES) failure and its relationship with clinical outcomes in patients with DES failure.
  
  
  BACKGROUND
  Time to DES failure is widely variable, but little information is available on the temporal patterns of DES failure and its impact on clinical outcomes.
  
  
  METHODS
  The angiographic patterns of DES failure and clinical outcomes in 633 patients with 676 lesions who presented with their first instance of DES failure were analyzed. The primary outcome was all-cause death following treatment for DES failure.
  
  
  RESULTS
  DES failure occurred in a median of 10.1 months after the index procedure. We identified 548 and 85 instances of DES restenosis (86.6%) and stent thrombosis (13.4%), respectively. Patients were divided into three groups according to the interval from the index procedure to DES failure: group 1 (early DES failure: <12 months), group 2 (late: 12-36 months), and group 3 (very late: ≥36 months). Acute myocardial infarction was more common in patients who developed failure after ≥12 months than patients with earlier presentations. Focal DES failure was more common in group 1, whereas nonfocal DES failure in groups 2 and 3. During follow-up after retreatment (median, 52.8 months), all-cause death was significantly higher in group 3 compared with group 1 (adjusted hazard ratio, 2.97; 95%CI, 1.31-6.74; P = 0.009). Similar findings were observed in terms of the rates of death or myocardial infarction.
  
  
  CONCLUSIONS
  Late DES failure is more likely to progress to acute myocardial infarction, aggressive angiographic patterns, and worse outcomes following retreatment.
authors.affiliation: Department of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea.
authors.forename: Cheol Whan
authors.initials: CW
authors.lastname: Lee
authors.forename: Jung-Min
authors.initials: JM
authors.lastname: Ahn
authors.forename: Sung-Han
authors.initials: SH
authors.lastname: Yoon
authors.forename: Jong-Young
authors.initials: JY
authors.lastname: Lee
authors.forename: Duk-Woo
authors.initials: DW
authors.lastname: Park
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Kang
authors.forename: Seung-Whan
authors.initials: SW
authors.lastname: Lee
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Park
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000209:etiology / Q000628:therapy; D003328:Coronary Thrombosis / Q000209:etiology / Q000628:therapy; D018450:Disease Progression; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D011475:Prosthesis Failure; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: drug-eluting stent; restenosis; temporal patterns