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Observational Study
. 2015 May;104(5):375-86.
doi: 10.5935/abc.20140216. Epub 2015 Feb 3.

Clinical Coronary In-Stent Restenosis Follow-Up after Treatment and Analyses of Clinical Outcomes

[Article in English, Portuguese]
Barbara Campos Abreu Marino  1 , Guilherme Abreu Nascimento  2 , Walter Rabelo  3 , Marcos Antônio Marino  2 , Roberto Luiz Marino  3 , Antonio Luiz Pinho Ribeiro  1
Affiliations
Observational Study

Clinical Coronary In-Stent Restenosis Follow-Up after Treatment and Analyses of Clinical Outcomes

[Article in English, Portuguese]
Barbara Campos Abreu Marino et al. Arq Bras Cardiol. 2015 May.

Abstract

Background: Clinical in-stent restenosis (CISR) is the main limitation of coronary angioplasty with stent implantation.

Objective: Describe the clinical and angiographic characteristics of CISR and the outcomes over a minimum follow-up of 12 months after its diagnosis and treatment.

Methods: We analyzed in 110 consecutive patients with CISR the clinical presentation, angiographic characteristics, treatment and combined primary outcomes (cardiovascular death, nonfatal acute myocardial infarction [AMI]) and combined secondary (unstable angina with hospitalization, target vessel revascularization and target lesion revascularization) during a minimal follow-up of one year.

Results: Mean age was 61 ± 11 years (68.2% males). Clinical presentations included acute coronary syndrome (ACS) in 62.7% and proliferative ISR in 34.5%. CISR was treated with implantation of drug-eluting stents (DES) in 36.4%, Bare Metal Stent (BMS) in 23.6%, myocardial revascularization surgery in 18.2%, balloon angioplasty in 15.5% and clinical treatment in 6.4%. During a median follow-up of 19.7 months, the primary outcome occurred in 18 patients, including 6 (5.5%) deaths and 13 (11.8%) AMI events. Twenty-four patients presented a secondary outcome. Predictors of the primary outcome were CISR with DES (HR = 4.36 [1.44-12.85]; p = 0.009) and clinical treatment for CISR (HR = 10.66 [2.53-44.87]; p = 0.001). Treatment of CISR with BMS (HR = 4.08 [1.75-9.48]; p = 0.001) and clinical therapy (HR = 6.29 [1.35-29.38]; p = 0.019) emerged as predictors of a secondary outcome.

Conclusion: Patients with CISR present in most cases with ACS and with a high frequency of adverse events during a medium-term follow-up.

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Conflict of interest statement

Potential Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Graph 1
Graph 1
Study design analyzing CISR patients after treatment. CISR: clinical in-stent restenosis; T: time
Graph 2
Graph 2
Kaplan-Meier curve of cardiovascular mortality and nonfatal heart attack according to CISR treatment (n = 110). Tx performed: treatment performed; CAGB: coronary bypass surgery; PCI: percutaneous coronary intervention; CISR: clinical in-stent restenosis.
Graph 3
Graph 3
Kaplan-Meier curve of cardiovascular mortality and non-fatal heart attack according to CISR with drug-eluting stent (n = 110). CISR: clinical in-stent restenosis.
Graph 4
Graph 4
Kaplan-Meier curve for TVR, TLR and UA according to the treatment of CISR (n = 110). TVR: target lesion revascularization; TLR: target vessel revascularization; UA: unstable angina; CISR: clinical in-stent restenosis; Performed Tx: performed treatment; CAGB: coronary bypass surgery; Balloon PCI: balloon percutaneous coronary intervention.
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