Age-related ten-year outcomes after percutaneous coronary intervention of in-stent restenosis

Abstract

Background: Older patients are often underrepresented in clinical trials investigating the treatment of coronary drug-eluting stent (DES) restenosis, but outcome data is urgently needed in an ageing society. Thus, the aim of this observational, retrospective study was to close this lack of evidence.

Methods: Between January 2007 and February 2021, 3511 patients with 5497 in-stent restenosis (ISR) lesions were treated at two large-volume centers in Munich, Germany. We compared the rates of cardiac death, myocardial infarction (MI) and repeat revascularization in 1105 patients (31.5 %) older than 75 years with 2406 patients (68.5 %) younger than 75 years. Survival was analyzed using the Kaplan-Meier method. Differences between the groups were tested with the log-rank test. Conventional multivariable analysis with adjustment for relevant variables was performed.

Results: Older patients were more frequently female (30.1 % vs. 17.9 %, p < 0.001) and presented less frequently with stable angina (67.8 % vs. 72.0 %, p < 0.001). After 10 years, the rates of cardiac death were 56.8 % in older patients and 27.4 % in younger patients (HR_adj, 2.45 [95 % CI, 2.09-2.88], p < 0.001). Accounting for the risk of death, no difference was found regarding the rates of MI while target lesion revascularization (TLR) occurred less frequently in older patients (24.2 % vs. 33.7 %; HR_adj, 0.77 [95 % CI, 0.66-0.89], p < 0.001).

Conclusions: In the long-term, rates of cardiac death after percutaneous coronary intervention of DES-ISR were higher and TLR rates were lower in patients older than 75 years. There was no difference in the rates of MI.

Keywords: Age; Drug-coated balloon; Drug-eluting stent; In-stent restenosis; Old; Percutaneous coronary intervention.