Document Detail

Repeat drug-eluting stent implantation for in-stent restenosis: first- or second-generation stent.
MedLine Citation:
PMID:  23117311     Owner:  NLM     Status:  In-Data-Review    
OBJECTIVE: To investigate the efficacy and safety of a second-generation drug-eluting stent (DES) for in-stent restenosis (ISR) after first-generation DES implantation.
BACKGROUND: The everolimus-eluting stent is a second-generation DES that is very effective for de novo coronary lesions.
METHODS: The subjects were 145 consecutive patients who underwent re-stenting, including 93 given a first-generation DES and 52 given a second-generation DES. The two groups were followed up for 37.8 ± 16.7 months and 13.8 ± 2.1 months, respectively. The primary endpoint was in-stent late luminal loss at 8-month angiographic follow-up.
RESULTS: Baseline clinical and angiographic parameters were similar in the 2 groups. Follow-up angiography showed that late luminal loss (0.26 ± 0.31 mm vs 0.58 ± 0.67 mm; P=.01), the binary restenosis rate (2.6% vs 16.7%; P=.03), and the target lesion revascularization (TLR) rate (1.9% vs 11.8%; log-rank = 0.04) were smaller in the second-generation group than in the first-generation group. There was no definite stent thrombosis in either group. During follow-up, there were no significant between-group differences of major adverse cardiac events without TLR, myocardial infarction, death, and death + myocardial infarction. Multivariate analysis demonstrated that using a first-generation DES was the only independent predictor of TLR after 1 year (odds ratio, 2.78; 95% confidence interval, 1.22-5.43; P=.03).
CONCLUSION: When ISR occurs after DES implantation, treatment with a second-generation DES reduces late luminal loss, binary restenosis, and TLR after 1 year compared with a first-generation DES.
Kennosuke Yamashita; Masahiko Ochiai; Tadayuki Yakushiji; Seitarou Ebara; Toshitaka Okabe; Myong Hwa Yamamoto; Shigeo Saito; Koichi Hoshimoto; Naoei Isomura; Hiroshi Araki; Chiaki Obara
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of invasive cardiology     Volume:  24     ISSN:  1557-2501     ISO Abbreviation:  J Invasive Cardiol     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-02     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8917477     Medline TA:  J Invasive Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  574-8     Citation Subset:  IM    
Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital.
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