Key result
Presentation with acute coronary syndrome in patients undergoing percutaneous coronary intervention for drug-eluting stent in-stent restenosis was associated with a significantly higher 10-year rate of cardiac death compared to chronic coronary syndrome (42.5% vs. 33.3%, HR 1.63).
Why the study?
Limited data are available on long-term outcomes after PCI of coronary DES in-stent restenosis depending on clinical presentation with ACS or CCS.
Does clinical presentation with ACS compared to CCS worsen long-term outcomes after PCI of DES-ISR?
Observational (n=3,511)
Yes
Does clinical presentation with ACS compared to CCS worsen long-term outcomes after PCI of DES-ISR?
Hazard Ratio: 1.63 (95% CI 1.41–1.88)
Absolute Event Rate: 42.5% vs 33.3%
p-value: p=<0.001
Patients presenting with ACS who undergo PCI for DES-ISR have significantly higher long-term risks of cardiac death, MI, and stent thrombosis compared to those presenting with CCS.
ACS presentation at DES ISR PCI signals higher long-term cardiac mortality; hypothesis-generating for intensified prevention strategies pending prospective confirmation.
BACKGROUND: Limited data are available on long-term outcomes after percutaneous coronary intervention (PCI) of coronary drug-eluting stent (DES) in-stent restenosis (ISR) depending on clinical presentation with acute coronary syndrome (ACS) or chronic coronary syndrome (CCS). AIMS: Thus, the aim of this observational, retrospective study was to address this lack of evidence. METHODS: Between January 2007 and February 2021, a total of 3,511 patients with 5,497 ISR lesions were treated at 2 large-volume centers in Munich, Germany, of which 1,029 (29.3%) were treated for ACS. Endpoints of interest were the rates of cardiac death, myocardial infarction (MI), repeat revascularization, and stent thrombosis (ST). 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: After ten years, the rates of cardiac death were 42.5% in patients with ACS and 33.3% in patients with CCS (HR 1.63 [95% CI, 1.41-1.88], p < 0.001). 17.4% of ACS patients and 9.5% of CCS patients experienced MI (HR 2.04 [95% CI, 1.65-2.50], p < 0.001). The rates of ST were 3.6% in patients with ACS and 1.2% in patients with CCS (HR 3.18 [95% CI, 1.92-5.24], p < 0.001). The rates of repeat revascularization of target lesion, target vessel and non-target vessel did not differ significantly between both groups in the long-term. CONCLUSIONS: In the long-term, the rates of cardiac death, MI and ST after PCI of DES-ISR are significantly higher in ACS patients than in CCS patients.
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Kuna et al. (2026) conducted an observational in In-stent restenosis of coronary drug-eluting stent (n=3,511). Acute coronary syndrome (ACS) presentation vs. Chronic coronary syndrome (CCS) presentation was evaluated on 10-year rate of cardiac death (HR 1.63, 95% CI 1.41-1.88, p=<0.001). Presentation with acute coronary syndrome in patients undergoing percutaneous coronary intervention for drug-eluting stent in-stent restenosis was associated with a significantly higher 10-year rate of cardiac death compared to chronic coronary syndrome (42.5% vs. 33.3%, HR 1.63).
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