Comparison of 2-year outcomes of repeated second-generation drug-eluting stent implantation for focal-type versus nonfocal-type in-stent restenosis

Zhu, Wenzhen; Li, Jing; Luo, Hongyu; Wang, Gang; Hua, Qi

doi:10.1097/mca.0000000000000283

Cited by 2 publications

(1 citation statement)

References 31 publications

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“…On the other hand, ISR lesions are different from coronary de novo lesions [21], which maybe in part contribute to these results in these special patients. At the same time, our study reveals that non-focal type and early ISR independently predict the adverse outcomes after PCI for DES-ISR with 2 nd generation DES, which indicates that mechanical factors underlying non-focal type or early ISR other than DM maybe play important roles in the repeat occurrence of ISR after PCI for DES-ISR lesions [22–24]. …”

Section: Discussionmentioning

confidence: 90%

Effect of diabetes mellitus on long-term outcomes after repeat drug-eluting stent implantation for in-stent restenosis

Zhao

Zhu

Zhang

et al. 2017

BMC Cardiovasc Disord

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BackgroundWhether diabetes mellitus (DM) is a predictor of long-term adverse clinical outcomes after repeat drug eluting stent (DES) implantation for DES in-stent restenosis (ISR) remains controversial. We sought to evaluate the effect of DM on the long-term clinical outcomes in patients undergoing repeat DES implantation for DES-ISR lesions.MethodsIn the present study, 254 patients with DES-ISR were divided into DM or non-DM groups according to the presence or absence of DM. All patients received repeat 2nd generation DES implantation for DES-ISR. The occurrences of major adverse cardiac events (MACEs) over a 2-year follow-up period were compared between the two groups. MACEs were defined as cardiac death, myocardial infarction (MI), and target lesion revascularization (TLR). MACE free survival was investigated with Kaplan-Meier curve analysis. Cox regression analysis was used to identify factors associated with MACEs.ResultsBaseline clinical characteristics were similar between groups, except for the prevalence of early restenosis (lower) in the DM group. Differences in angiographic and procedural characteristics were not significant between groups. The rates of 2-year MACE (30.9 vs. 26.0%; P = 0.453) and TLR (24.7 vs. 19.7%; P = 0.411) were similar between groups. MACE-free survival and TLR-free survival were also similar between groups (P = 0.441 and P = 0.807). Subgroup analysis suggested a significant difference in the MACE (39.0 vs.15.3%, P < 0.001) and TLR occurrence (30.5 vs.8.2%, P < 0.001) and TLR-free survival (lower in early subgroup, P < 0.001) between early and late occurrence of ISR in the non-DM group of patients but not in the DM group. After adjustment for all significant clinical variables, Cox regression analysis indicated that DM was not associated with MACEs (hazard ratio [HR] 1.531, 95% confidence interval [CI] 0.882-2.658, P =0.130). Non-focal type ISR and early ISR were predictors of MACEs (HR 2.671, 95% CI 1.468-4.858,P = 0.001; HR 4.703, 95% CI 2.725-8.117, P < 0.001, respectively).ConclusionsPatients with DM have similar 2-year clinical outcomes to patients without DM when repeat 2nd generation DES was used for treatment of DES-ISR. DM is not the predictor of long-term prognosis in patients undergoing repeat 2nd generation DES for DES-ISR.

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Section: Discussionmentioning

confidence: 90%

Effect of diabetes mellitus on long-term outcomes after repeat drug-eluting stent implantation for in-stent restenosis

Zhao

Zhu

Zhang

et al. 2017

BMC Cardiovasc Disord

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Impact of hyperuricemia on clinical outcomes after percutaneous coronary intervention for in-stent restenosis

Joo

Jeong

Kook

et al. 2018

BMC Cardiovasc Disord

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BackgroundThere have been limited data on the impact of hyperuricemia on long-term clinical outcomes after percutaneous coronary intervention (PCI) for in-stent restenosis (ISR).MethodsFrom January 2009 to July 2015, 317 patients who underwent repeat PCI for ISR were divided into two groups: patients with normal serum uric acid (UA) levels (normal UA group) and patients with higher serum UA levels (higher UA group). The higher UA group included patients with serum UA levels > 6.8 mg/dL or patients who were taking anti-hyperuricemic medication.ResultsDuring a median follow-up period of 1088 days, the cumulative incidence rates of major adverse event (MAE), including a composite of all-cause death, non-fatal myocardial infarction, and any revascularization, were similar between the two groups (higher UA 36.4% vs. normal UA 29.9%, p = 0.389, log-rank p = 0.367). Follow-up angiographic data showed similar outcomes of late lumen loss (0.8 ± 0.9 mm vs. 0.8 ± 1.1 mm, p = 0.895) and binary restenosis rate (28.1% vs. 34.7%, p = 0.622). Multivariate Cox regression analysis indicated higher levels of low-density lipoprotein cholesterol (hazard ratio [HR] 1.011, 95% confidence interval [CI] 1.003–1.019, p = 0.006) and lower left ventricular ejection fraction (HR 0.972, 95% CI 0.948–0.996, p = 0.022), but not UA levels, to be the independent risk predictors of MAE.ConclusionHyperuricemia is not associated with poor clinical outcomes after repeat PCI for ISR lesions.Electronic supplementary materialThe online version of this article (10.1186/s12872-018-0840-2) contains supplementary material, which is available to authorized users.

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Comparison of 2-year outcomes of repeated second-generation drug-eluting stent implantation for focal-type versus nonfocal-type in-stent restenosis

Abstract: In the current study, second-generation DES is more effective in the treatment of focal-type DES-ISR than nonfocal-type ISR in terms of the occurrence of MACEs. Nonfocal-type ISR is an independent predictor of MACEs after the treatment of DES-ISR with second-generation DES.

Cited by 2 publications

References 31 publications

Effect of diabetes mellitus on long-term outcomes after repeat drug-eluting stent implantation for in-stent restenosis

Effect of diabetes mellitus on long-term outcomes after repeat drug-eluting stent implantation for in-stent restenosis

Impact of hyperuricemia on clinical outcomes after percutaneous coronary intervention for in-stent restenosis

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