Characterization and clinical outcomes of drug-eluting in-stent restenosis.

BACKGROUND

The best therapeutic alternative for patients suffering from in-stent restenosis after drug-eluting stent implantation remains to be elucidated.

OBJECTIVE

To characterize the pattern, treatment and outcomes of DES-related in-stent restenosis in patients treated at our institution.

METHODS

We determined the incidence and major adverse clinical events in 71 consecutive patients with DES failure among 2473 patients who were treated with 2548 drug-eluting stents between 2004 and 2007. We analyzed the clinical data, procedural parameters and clinical outcomes.

RESULTS

The type and number of stents implanted were as follows: Cypher (n = 1808), Endeavor (421) and Taxus (319); of these, 53 (2.9%), 10 (2.4%), and 8 (2.5%) patients respectively presented with restenosis. The mean time to restenosis was 11.3 +/- 9.9 months. Patients' mean age was 65 +/- 11 years; 75% were male, and 68% had diabetes mellitus. Unstable angina was the clinical presentation in 52 (73%). At 6 months, 3 patients had developed myocardial infarction (4.2%), repeat restenosis at follow-up was diagnosed in 8 patients (11.3%), the overall major adverse clinical events rate was 18.3% (13 patients), and 2 patients died (2.8%).

CONCLUSIONS

Drug-eluting stent-related restenosis is relatively infrequent but remains a clinical challenge. It occurs more frequently in complex lesion subsets, but the overall intermediate-term prognosis is tolerable.