Key result
Early drug-eluting stent in-stent restenosis (<12 months) was associated with a significantly higher rate of major adverse cardiac events at 12 months compared to late restenosis (37.5% vs. 5.5%; OR 13.267).
Why the study?
The mechanisms and characteristics of early and late DES-ISR are not fully clarified, and whether outcomes differ irrespective of repeated treatments remains a knowledge gap.
Does early DES-ISR (<12 months) compared to late DES-ISR (≥12 months) predict worse clinical outcomes in patients undergoing repeated percutaneous coronary intervention?
Cohort (n=250)
No
Does early DES-ISR (<12 months) compared to late DES-ISR (≥12 months) predict worse clinical outcomes in patients undergoing repeated percutaneous coronary intervention?
Odds Ratio: 13.267 (95% CI 4.984–35.311)
Absolute Event Rate: 37.5% vs 5.5%
p-value: p=<0.001
Early DES-ISR (<12 months) and left ventricular systolic dysfunction are strong independent predictors of major adverse cardiac events at 12 months following repeated PCI.
Early DES-ISR may support risk stratification after repeat PCI; leaves open whether timing modifies outcomes in randomized trials.
BACKGROUND: The mechanism and characteristics of early and late drug-eluting stent in-stent restenosis (DES-ISR) have not been fully clarified. Whether there are different outcomes among those patients being irrespective of their repeated treatments remain a knowledge gap. METHODS: A total of 250 patients who underwent initial stent implantation in our hospital, and then were readmitted to receive treatment for the reason of recurrent significant DES-ISR in 2016 were involved. The patients were categorized as early ISR (<12 months; E-ISR; n = 32) and late ISR (≥12 months; L-ISR; n = 218). Associations between patient characteristics and clinical performance, as well as clinical outcomes after a repeated percutaneous coronary intervention (PCI) were evaluated. Primary composite endpoint of major adverse cardiac events (MACEs) included cardiac death, non-fatal myocardial infarction (MI), or target lesion revascularization (TLR). RESULTS: Most baseline characteristics are similar in both groups, except for the period of ISR, initial pre-procedure thrombolysis in myocardial infarction, and some serum biochemical indicators. The incidence of MACE (37.5% vs. 5.5%; P < 0.001) and TLR (37.5% vs. 5.0%; P < 0.001) is higher in the E-ISR group. After multivariate analysis, E-ISR (odds ratio [OR], 13.267; [95% CI 4.984-35.311]; P < 0.001) and left ventricular systolic dysfunction (odds ratio [OR], 6.317; [95% CI 1.145-34.843]; P = 0.034) are the independent predictors for MACE among DES-ISR patients in the mid-term follow-up of 12 months. CONCLUSIONS: Early ISR and left ventricular systolic dysfunction are associated with MACE during the mid-term follow-up period for DES-ISR patients. The results may benefit the risk stratification and secondary prevention for DES-ISR patients in clinical practice.
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Zheng et al. (2020) conducted a cohort in Drug-eluting stent in-stent restenosis (DES-ISR) (n=250). Early in-stent restenosis (<12 months) vs. Late in-stent restenosis (≥12 months) was evaluated on Major adverse cardiac events (MACEs) including cardiac death, non-fatal myocardial infarction, or target lesion revascularization (OR 13.267, 95% CI 4.984-35.311, p=<0.001). Early drug-eluting stent in-stent restenosis (<12 months) was associated with a significantly higher rate of major adverse cardiac events at 12 months compared to late restenosis (37.5% vs. 5.5%; OR 13.267).
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