Incidence and predictors of recurrent restenosis following implantation of drug‐eluting stents for in‐stent restenosis

OBJECTIVES: We investigated the incidence and predictors of recurrent restenosis after drug-eluting stent (DES) implantation for in-stent restenosis (ISR) in routine clinical practice. BACKGROUND: Although DESs have been increasingly used for treatment of ISR, little is known about the predictors of DES failure. METHODS: We determined the incidence of recurrent restenosis and major adverse cardiac events (MACE) in 224 consecutive patients with 239 lesions treated with sirolimus-eluting (n=217 lesions) or paclitaxel-eluting (n=22 lesions) stents for the first episode of ISR. RESULTS: The procedural success rate was 99.2%, and in-hospital complications did not occur in any patient. Follow-up angiography at 6 months was obtained in 73.7% of patients. Angiographic re-restenosis rate was 12.6%, and target lesion revascularization was required in 7.6% of patients. Of the 22 incidents of re-restenosis, 15 were focal (68.2%), 5 were diffuse (22.7%), and 2 were total (9.1%) restenosis. Univariate analysis showed that lesion length, use of paclitaxel-eluting stent, and number of stents per lesion were significant predictors of re-restenosis. In multivariate analysis, however, lesion length and use of paclitaxel-eluting stent were independent predictors of re-restenosis. During the follow-up (mean, 18.3+/-8.1 months), there were 4 deaths (1 cardiac, 3 noncardiac), but no nonfatal myocardial infarctions (MIs). MACE occurred in 18 patients. The cumulative probability of MACE-free survival was 92.9+/-1.8% at 1 year and 90.5+/-2.4% at 2 years. CONCLUSIONS: DESs are highly effective for treatment of ISR, with recurrent restenosis related to lesion length and type of DES.