title: Clinical Coronary In-Stent Restenosis Follow-Up after Treatment and Analyses of Clinical Outcomes.
abstract: BACKGROUND
  Clinical in-stent restenosis (CISR) is the main limitation of coronary angioplasty with stent implantation.
  
  
  OBJECTIVE
  Describe the clinical and angiographic characteristics of CISR and the outcomes over a minimum follow-up of 12 months after its diagnosis and treatment.
  
  
  METHODS
  We analyzed in 110 consecutive patients with CISR the clinical presentation, angiographic characteristics, treatment and combined primary outcomes (cardiovascular death, nonfatal acute myocardial infarction [AMI]) and combined secondary (unstable angina with hospitalization, target vessel revascularization and target lesion revascularization) during a minimal follow-up of one year.
  
  
  RESULTS
  Mean age was 61 ± 11 years (68.2% males). Clinical presentations included acute coronary syndrome (ACS) in 62.7% and proliferative ISR in 34.5%. CISR was treated with implantation of drug-eluting stents (DES) in 36.4%, Bare Metal Stent (BMS) in 23.6%, myocardial revascularization surgery in 18.2%, balloon angioplasty in 15.5% and clinical treatment in 6.4%. During a median follow-up of 19.7 months, the primary outcome occurred in 18 patients, including 6 (5.5%) deaths and 13 (11.8%) AMI events. Twenty-four patients presented a secondary outcome. Predictors of the primary outcome were CISR with DES (HR = 4.36 [1.44-12.85]; p = 0.009) and clinical treatment for CISR (HR = 10.66 [2.53-44.87]; p = 0.001). Treatment of CISR with BMS (HR = 4.08 [1.75-9.48]; p = 0.001) and clinical therapy (HR = 6.29 [1.35-29.38]; p = 0.019) emerged as predictors of a secondary outcome.
  
  
  CONCLUSIONS
  Patients with CISR present in most cases with ACS and with a high frequency of adverse events during a medium-term follow-up.
authors: Programa de Pós-Graduação em Ciências da Saúde do Adulto, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil.
authors: Barbara Campos Abreu
authors: BC
authors: Marino
authors: Departamento de Cardiologia Intervencionista, Hospital Madre Teresa, Belo Horizonte, Minas Gerais, Brasil.
authors: Guilherme Abreu
authors: GA
authors: Nascimento
authors: Departamento de Cardiologia do Hospital Madre Teresa, Hospital Madre Teresa, Belo Horizonte, Minas Gerais, Brasil.
authors: Walter
authors: W
authors: Rabelo
authors: Departamento de Cardiologia Intervencionista, Hospital Madre Teresa, Belo Horizonte, Minas Gerais, Brasil.
authors: Marcos Antônio
authors: MA
authors: Marino
authors: Departamento de Cardiologia do Hospital Madre Teresa, Hospital Madre Teresa, Belo Horizonte, Minas Gerais, Brasil.
authors: Roberto Luiz
authors: RL
authors: Marino
authors: Programa de Pós-Graduação em Ciências da Saúde do Adulto, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil.
authors: Antonio Luiz Pinho
authors: AL
authors: Ribeiro
mesh_terms: D054058:Acute Coronary Syndrome / Q000209:etiology / Q000401:mortality / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000209:etiology / Q000401:mortality / Q000628:therapy; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D004812:Epidemiologic Methods; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
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