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. 2021 Aug 6;17(5):e380-e387.
doi: 10.4244/EIJ-D-19-01031.

Long-term outcomes of percutaneous coronary intervention for in-stent restenosis among Medicare beneficiaries

Hector Tamez  1 , Eric A Secemsky, Linda R Valsdottir, Issam D Moussa, Yang Song, Charles A Simonton, C Michael Gibson, Jeffrey J Popma, Robert W Yeh
Affiliations

Long-term outcomes of percutaneous coronary intervention for in-stent restenosis among Medicare beneficiaries

Hector Tamez et al. EuroIntervention. .

Abstract

Background: In-stent restenosis (ISR) is highly prevalent and leads to repeat revascularisation. Long-term implications of ISR are poorly understood.

Aims: This study aimed to evaluate the long-term outcomes of patients undergoing percutaneous coronary intervention (PCI) for ISR.

Methods: National Cardiovascular Data Registry CathPCI records for individuals aged ≥65 years undergoing PCI from July 2009 to December 2014 were linked to Medicare claims. Baseline characteristics and long-term rates of death, myocardial infarction (MI), repeat revascularisation including target vessel revascularisation (TVR), and major adverse cardiovascular and cerebrovascular events (MACCE) were compared between ISR PCI versus de novo lesion PCI.

Results: Of 653,304 individuals, 10.2% underwent ISR PCI and 89.8% underwent de novo lesion PCI. The median duration of follow-up was 825 days (quartile 1: 352 days-quartile 3: 1,379 days). The frequency of MACCE (55.6% vs 45.0%; p<0.001), all-cause mortality (27.8% vs 25.5%; p<0.001), MI (19.0% vs 12.3%; p<0.001), repeat revascularisation (31.9% vs 18.6%; p<0.001), TVR (22.4% vs 8.0%; p<0.001), and stroke (8.8% vs 8.3%; p=0.005) was higher after ISR PCI. After multivariable adjustment, ISR PCI remained associated with worse long-term outcomes than after de novo lesion PCI (hazard ratio [HR] for MACCE 1.24 [95% CI: 1.22, 1.26], mortality 1.07 [95% CI: 1.05, 1.09], MI 1.44 [95% CI: 1.40, 1.48], repeat revascularisation 1.55 [95% CI: 1.51, 1.59], and TVR 2.50 [95% CI: 2.42, 2.58]).

Conclusions: ISR PCI was common and was associated with a significantly higher risk of recurrent long-term major ischaemic events compared to patients undergoing de novo lesion PCI. There remains a need for new strategies to minimise ISR.

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Conflict of interest statement

E.A. Secemsky reports grants/personal fees from Medtronic, CSI, Boston Scientific, Philips, Cook Medical, BD Bard, AstraZeneca, Janssen. C.A. Simonton is a former employee of Abbott Vascular, and an employee of Abiomed. C.M. Gibson received research support and consultant fees from Janssen Pharmaceuticals, Johnson and Johnson, Bayer, and Portola, as well as research support from the Baim Institute for Clinical Research. J.J. Popma is an employee of Medtronic and is not affiliated with Beth Israel Deaconess Medical Center. He reports grants from Medtronic, Boston Scientific, Abbott, and Edwards Lifesciences. R.W. Yeh received a research grant, consulting, and advisory board fees from Abbott Vascular, Boston Scientific, and Medtronic. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Cumulative incidence of primary and secondary outcomes in patients undergoing ISR PCI and de novo lesion PCI. The cumulative incidence of major adverse cardiovascular and cerebrovascular events (A), all-cause mortality (B), myocardial infarction (C), stroke (D), repeat revascularisation (E) and target vessel revascularisation (F) in patients undergoing ISR PCI (red line) versus de novo lesion PCI (blue line).
Figure 3
Figure 3
Cumulative incidence of primary and secondary outcomes in patients undergoing ISR PCI and de novo lesion PCI with history of prior PCI. The cumulative incidence of major adverse cardiovascular and cerebrovascular events (A), all-cause mortality (B), myocardial infarction (C), stroke (D), repeat revascularisation (E) and target vessel revascularisation (F) in patients undergoing ISR PCI (red line) versus de novo lesion PCI (blue line).
See this image and copyright information in PMC

References

    1. Chan PS, Patel MR, Klein LW, Krone RJ, Dehmer GJ, Kennedy K, Nallamothu BK, Weaver WD, Masoudi FA, Rumsfeld JS, Brindis RG, Spertus JA. Appropriateness of percutaneous coronary intervention. JAMA. 2011;306:53–61. - PMC - PubMed
    1. Dangas GD, Claessen BE, Caixeta A, Sanidas EA, Mintz GS, Mehran R. In-stent restenosis in the drug-eluting stent era. J Am Coll Cardiol. 2010;56:1897–907. doi: 10.1016/j.jacc.2010.07.028. - DOI - PubMed
    1. Kimura T, Morimoto T, Nakagawa Y, Kawai K, Miyazaki S, Muramatsu T, Shiode N, Namura M, Sone T, Oshima S, Nishikawa H, Hiasa Y, Hayashi Y, Nobuyoshi M, Mitudo K j-Cypher Registry Investigators. Very late stent thrombosis and late target lesion revascularization after sirolimus-eluting stent implantation: five-year outcome of the j-Cypher Registry. Circulation. 2012;125:584–91. - PubMed
    1. Räber L, Wohlwend L, Wigger M, Togni M, Wandel S, Wenaweser P, Cook S, Moschovitis A, Vogel R, Kalesan B, Seiler C, Eberli F, Lüscher TF, Meier B, Juni P and Windecker S. Five-year clinical and angiographic outcomes of a randomized comparison of sirolimus-eluting and paclitaxel-eluting stents: results of the Sirolimus-Eluting Versus Paclitaxel-Eluting Stents for Coronary Revascularization LATE trial. Circulation. 2011;123:2819–28, 6 p following 2828. doi: 10.1161/CIRCULATIONAHA.110.004762. - DOI - PubMed
    1. Kereiakes DJ, Ellis SG, Metzger C, Caputo RP, Rizik DG, Teirstein PS, Litt MR, Kini A, Kabour A, Marx SO, Popma JJ, McGreevy R, Zhang Z, Simonton C, Stone GW ABSORB III Investigators. 3-Year Clinical Outcomes With Everolimus-Eluting Bioresorbable Coronary Scaffolds: The ABSORB III Trial. J Am Coll Cardiol. 2017;70:2852–62. - PubMed