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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Long-term outcomes after the percutaneous treatment of drug-eluting stent restenosis
JACC: Cardiovascular Interventions, Volume 4, No. 2, Year 2011
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Description
Objectives This study sought to evaluate the long-term angiographic and clinical outcomes after the treatment of drug-eluting stent in-stent restenosis (DES-ISR) based on the angiographic pattern of restenosis. Background Long-term outcomes after percutaneous treatment of DES-ISR are unclear. Methods This study performed a retrospective analysis of 481 consecutive de novo DES-ISR lesions (n = 392) treated percutaneously between August 2002 and July 2007. The lesions were divided based on the pattern of restenosis: focal (305; 63.4%), diffuse (120; 24.9%), and occlusive (56; 11.6%). Results The majority (65%) of patients had angina or ischemia on presentation and 13% had an acute coronary syndrome. Angiographic follow-up after treatment of DES-ISR was available in 65.5% of lesions. A second angiographic restenosis occurred in 29.1% of the focal group, 45.8% (p = 0.007) of the diffuse, and 65.6% (p < 0.0001) of the occlusive. The pattern of DES-ISR predicted the pattern of recurrence: occlusive reoccluded in 66.7%; diffuse recurred as diffuse or occlusive in 57.9%; focal as focal in 67.2%. During a median follow-up of 2.97 years (interquartile range: 2.37 to 3.89), major adverse cardiac events occurred in 32.8% of patients with no significant differences among the focal, diffuse, and occlusive groups (30.9%, 38.7%, 31.1%; p = 0.38). Diffuse restenosis was associated with a significantly higher target lesion revascularization rate compared with focal (27.1% vs. 15.8%; p = 0.008). A disparity between restenosis (65.6%) and target lesion revascularization (18.5%) rates for occlusive DES-ISR suggests that as many recurrent restenoses were occlusive, they were not retreated. Conclusions DES-ISR identifies a high-risk cohort that is at an increased risk of events, in particular repeat revascularization, during long-term follow-up. The initial pattern of restenosis is the most important predictor of recurrent restenosis or the need for subsequent reintervention. © 2011 American College of Cardiology Foundation.
Authors & Co-Authors
Latib, Azeem M.
Italy, Milan
Irccs Ospedale San Raffaele
Italy, Milan
Emo Centro Cuore Columbus
South Africa, Cape Town
University of Cape Town
Mussardo, Marco
Italy, Milan
Irccs Ospedale San Raffaele
Ielasi, A.
Italy, Milan
Irccs Ospedale San Raffaele
Tarsia, Giandomenico
Italy, Potenza
Ospedale San Carlo, Potenza
Godino, Cosmo
Italy, Milan
Irccs Ospedale San Raffaele
Italy, Milan
Emo Centro Cuore Columbus
Al-Lameé, Rasha Kadem
Italy, Potenza
Ospedale San Carlo, Potenza
Chieffo, Alaide
Italy, Milan
Irccs Ospedale San Raffaele
Airoldi, Flavio
Italy, Milan
Irccs Multimedica
Carlino, Mauro
Italy, Milan
Irccs Ospedale San Raffaele
Montorfano, Matteo
Italy, Milan
Irccs Ospedale San Raffaele
Colombo, Antonio
Italy, Milan
Irccs Ospedale San Raffaele
Italy, Milan
Emo Centro Cuore Columbus
Statistics
Citations: 67
Authors: 11
Affiliations: 5
Identifiers
Doi:
10.1016/j.jcin.2010.09.027
ISSN:
19368798
Research Areas
Noncommunicable Diseases
Study Design
Cohort Study