BackgroundClinical in-stent restenosis (CISR) is the main limitation of coronary angioplasty
with stent implantation.ObjectiveDescribe the clinical and angiographic characteristics of CISR and the outcomes
over a minimum follow-up of 12 months after its diagnosis and treatment.MethodsWe 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.ResultsMean 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.ConclusionPatients with CISR present in most cases with ACS and with a high frequency of
adverse events during a medium-term follow-up.