Document Detail


Repeat Revascularization After Contemporary Percutaneous Coronary Intervention: An Evaluation of Staged, Target Lesion, and Other Unplanned Revascularization Procedures During the First Year.
MedLine Citation:
PMID:  23093553     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: ALTHOUGH DRUG-ELUTING STENTS AND INTENSIVE SECONDARY PREVENTION HAVE CONTRIBUTED TO IMPROVED OUTCOMES AFTER PERCUTANEOUS CORONARY INTERVENTION (PCI), REPEAT REVASCULARIZATION REMAINS RELATIVELY COMMON IN CONTEMPORARY PRACTICE. WE USED DATA FROM THE MULTICENTER EVALUATION OF DRUG-ELUTING STENTS AND ISCHEMIC EVENTS REGISTRY TO EVALUATE THE RELATIVE FREQUENCY AND TIMING OF STAGED REVASCULARIZATION, TARGET LESION REVASCULARIZATION (TLR), AND OTHER NONTARGET REVASCULARIZATION DURING THE FIRST YEAR AFTER CONTEMPORARY PCI.METHODS AND RESULTS: PATIENTS WITH STAGED REVASCULARIZATION, TLR, AND OTHER UNPLANNED PROCEDURES (ELSEWHERE IN THE TARGET VESSEL OR IN OTHER CORONARY ARTERIES) WERE EVALUATED IN TIME-DEPENDENT MODELS USING KAPLAN-MEIER LIFE-TABLE ESTIMATION. PREDICTORS OF TLR AND UNPLANNED REVASCULARIZATION AT NONTARGET SITES WERE IDENTIFIED USING LOGISTIC REGRESSION. BETWEEN JULY 2004 TO JUNE 2007, 10 144 PATIENTS UNDERGOING PCI WERE ENROLLED AT 55 US HOSPITALS, OF WHOM 86% WERE TREATED WITH AT LEAST 1 DRUG-ELUTING STENT. TWELVE PERCENT REQUIRED REPEAT REVASCULARIZATION WITHIN THE FIRST YEAR (3% STAGED; 9% UNPLANNED). MORE THAN 75% OF STAGED REVASCULARIZATIONS WERE PERFORMED 30 DAYS AFTER INDEX PCI, ALTHOUGH THERE WAS SIGNIFICANT VARIATION IN THIS PRACTICE ACROSS HOSPITALS (RANGE, 0%54%). TLR OCCURRED IN 4.5% OF PATIENTS, WITH HIGHER HAZARD RATES BETWEEN 2 TO 9 MONTHS AFTER PCI, WHEREAS THE RISK OF UNPLANNED NON-TLR (4.4% CUMULATIVE INCIDENCE) WAS CONSTANT OVER TIME.CONCLUSIONS: Among unselected patients undergoing PCI in the drug-eluting stent era, the incidence of repeat revascularization at 1 year is ≈12%. Among unplanned procedures, only half are performed for TLR. To achieve further improvements in PCI outcomes, future efforts should concentrate as much on identifying ischemia-producing lesions and intensifying secondary prevention therapies as on the prevention of restenosis.
Authors:
Joshua M Stolker; David J Cohen; Kevin F Kennedy; Michael J Pencina; Jason B Lindsey; Laura Mauri; Donald E Cutlip; Neal S Kleiman;
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-23
Journal Detail:
Title:  Circulation. Cardiovascular interventions     Volume:  -     ISSN:  1941-7632     ISO Abbreviation:  Circ Cardiovasc Interv     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101499602     Medline TA:  Circ Cardiovasc Interv     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Division of Cardiology, Saint Louis University, Saint Louis, MO.
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