Document Detail


Clinical presentation and outcome of patients hospitalized for symptomatic in-stent restenosis treated by percutaneous coronary intervention: comparison between drug-eluting stents and bare-metal stents.
MedLine Citation:
PMID:  19375675     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In-stent restenosis remains the major limitation of percutaneous coronary intervention (PCI), particularly after bare-metal stent (BMS) implantation. Drug-eluting stents (DES) decrease in-stent restenosis, which is thought to have minimal clinical consequences, but may increase the risk of stent thrombosis and its attendant high mortality rate.
AIMS: To assess the clinical consequences of in-stent restenosis, including severity of associated illness and acute and 1-year outcomes and to compare DES and BMS in-stent restenosis.
METHODS: Using our prospective PCI registry, we compared data from 1958 consecutive patients hospitalized with BMS in-stent restenosis between January 2000 and April 2003 and all 190 patients with DES in-stent restenosis admitted between April 2003 and September 2006. Risk-adjusted outcomes were calculated using propensity-score matching.
RESULTS: An unstable presentation was noted in 78.1% of 2148 patients. Patients with DES in-stent restenosis presented more often with acute myocardial infarction (4.3% versus 1.6%, p<0.001). At 1 year, mortality for all patients was 5.7% and target-vessel revascularization was 21.5%. After risk adjustment, target-vessel revascularization and target-vessel revascularization-major adverse cardiac events were greater in patients with DES in-stent restenosis (respectively, 27.8% versus 19.7%, p=0.05; 32.5% versus 24.3%, p=0.06).
CONCLUSION: In-stent restenosis is associated with unstable presentation and a higher 1-year adverse events rate than expected in patients undergoing elective PCI. For an identical level of cardiac risk, it seems that DES in-stent restenosis outcomes are slightly worse than BMS in-stent restenosis outcomes.
Authors:
Axel De Labriolle; Laurent Bonello; Gilles Lemesle; Daniel H Steinberg; Probal Roy; Zhenyi Xue; Kimberly Kaneshige; William O Suddath; Lowell F Satler; Kenneth M Kent; Augusto D Pichard; Joseph Lindsay; Ron Waksman
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-03-17
Journal Detail:
Title:  Archives of cardiovascular diseases     Volume:  102     ISSN:  1875-2136     ISO Abbreviation:  Arch Cardiovasc Dis     Publication Date:  2009 Mar 
Date Detail:
Created Date:  2009-04-20     Completed Date:  2009-06-19     Revised Date:  2011-04-25    
Medline Journal Info:
Nlm Unique ID:  101465655     Medline TA:  Arch Cardiovasc Dis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  209-17     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, Division of Cardiology, Washington Hospital Center, 110, Irving Street, NW, Suite 4B-1, Washington DC 20010, USA.
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / etiology
Aged
Angioplasty, Balloon, Coronary / adverse effects*,  instrumentation*,  mortality
Coronary Angiography
Coronary Restenosis / etiology*,  mortality,  radiography
Drug-Eluting Stents*
Female
Hospitalization*
Humans
Male
Metals*
Middle Aged
Myocardial Infarction / etiology
Prosthesis Design
Registries
Retrospective Studies
Risk Assessment
Severity of Illness Index
Stents*
Thrombosis / etiology
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Metals

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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