Key result
Older age (>75 years) was associated with a higher 10-year rate of cardiac death compared to younger age after percutaneous coronary intervention for in-stent restenosis (HR 2.45; 95% CI 2.09-2.88).
Why the study?
Older patients are often underrepresented in clinical trials investigating the treatment of coronary drug-eluting stent restenosis, despite an urgent need for outcome data in an ageing society.
Does age >75 years increase the rates of cardiac death, myocardial infarction, and repeat revascularization in patients undergoing percutaneous coronary intervention for in-stent restenosis?
Observational (n=3,511)
Yes
Does age >75 years increase the rates of cardiac death, myocardial infarction, and repeat revascularization in patients undergoing percutaneous coronary intervention for in-stent restenosis?
Following percutaneous coronary intervention for drug-eluting stent in-stent restenosis, patients older than 75 years experience significantly higher 10-year cardiac mortality but lower rates of target lesion revascularization compared to younger patients.
Background: Older patients are often underrepresented in clinical trials investigating the treatment of coronary drug-eluting stent (DES) restenosis, but outcome data is urgently needed in an ageing society.Thus, the aim of this observational, retrospective study was to close this lack of evidence.Methods: Between January 2007 and February 2021, 3511 patients with 5497 in-stent restenosis (ISR) lesions were treated at two large-volume centers in Munich, Germany.We compared the rates of cardiac death, myocardial infarction (MI) and repeat revascularization in 1105 patients (31.5 %) older than 75 years with 2406 patients (68.5 %) younger than 75 years.Survival was analyzed using the Kaplan-Meier method.Differences between the groups were tested with the log-rank test.Conventional multivariable analysis with adjustment for relevant variables was performed.Results: Older patients were more frequently female (30.1 % vs. 17.9 %, p < 0.001) and presented less frequently with stable angina (67.8 % vs. 72.0%, p < 0.001).After 10 years, the rates of cardiac death were 56.8 % in older patients and 27.4 % in younger patients (HR adj , 2.45 [95 % CI, 2.09-2.88],p < 0.001).Accounting for the risk of death, no difference was found regarding the rates of MI while target lesion revascularization (TLR) occurred less frequently in older patients (24.2 % vs. 33.7 %; HR adj , 0.77 [95 % CI, 0.66-0.89],p < 0.001).Conclusions: In the long-term, rates of cardiac death after percutaneous coronary intervention of DES-ISR were higher and TLR rates were lower in patients older than 75 years.There was no difference in the rates of MI.
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Kuna et al. (2025) conducted an observational in in-stent restenosis (ISR) (n=3,511). Age > 75 years vs. Age < 75 years was evaluated on cardiac death (HR 2.45, 95% CI 2.09-2.88, p=< 0.001). Older age (>75 years) was associated with a higher 10-year rate of cardiac death compared to younger age after percutaneous coronary intervention for in-stent restenosis (HR 2.45; 95% CI 2.09-2.88).
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