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Clinical Coronary In-Stent Restenosis Follow-Up after Treatment and Analyses of Clinical Outcomes.

Marino BC, Nascimento GA, Rabelo W, Marino MA, Marino RL, Ribeiro AL - Arq. Bras. Cardiol. (2015)

Bottom Line: Twenty-four patients presented a secondary outcome.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.Patients with CISR present in most cases with ACS and with a high frequency of adverse events during a medium-term follow-up.

View Article: PubMed Central - PubMed

Affiliation: Programa de Pós-Graduação em Ciências da Saúde do Adulto, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil.

ABSTRACT

Background: Clinical in-stent restenosis (CISR) is the main limitation of coronary angioplasty with stent implantation.

Objective: Describe the clinical and angiographic characteristics of CISR and the outcomes over a minimum follow-up of 12 months after its diagnosis and treatment.

Methods: We 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.

Results: Mean 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.

Conclusion: Patients with CISR present in most cases with ACS and with a high frequency of adverse events during a medium-term follow-up.

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Related in: MedlinePlus

Kaplan-Meier curve for TVR, TLR and UA according to the treatment of CISR (n =110). TVR: target lesion revascularization; TLR: target vessel revascularization;UA: unstable angina; CISR: clinical in-stent restenosis; Performed Tx: performedtreatment; CAGB: coronary bypass surgery; Balloon PCI: balloon percutaneouscoronary intervention.
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f04: Kaplan-Meier curve for TVR, TLR and UA according to the treatment of CISR (n =110). TVR: target lesion revascularization; TLR: target vessel revascularization;UA: unstable angina; CISR: clinical in-stent restenosis; Performed Tx: performedtreatment; CAGB: coronary bypass surgery; Balloon PCI: balloon percutaneouscoronary intervention.

Mentions: As for the secondary outcome, univariate analysis identified clinical treatment of CISR(HR = 6.46; 95% CI 1.22–34.00; p = 0.028) and treatment of CISR with a BMS (HR = 4.18;95% CI 1.46–11.89; p = 0.007). These factors remained as independent predictors in themultivariate analysis of the risk of the combined outcome of UA with readmission, TVRand TLR, clinical treatment of CISR (HR = 6.29; 95% CI 1.35–29.38; p = 0.019) andtreatment of CISR with implantation of a BMS (HR = 4.08; 95% CI 1.75–9.48; p = 0.001;Table 4; Graph4).


Clinical Coronary In-Stent Restenosis Follow-Up after Treatment and Analyses of Clinical Outcomes.

Marino BC, Nascimento GA, Rabelo W, Marino MA, Marino RL, Ribeiro AL - Arq. Bras. Cardiol. (2015)

Kaplan-Meier curve for TVR, TLR and UA according to the treatment of CISR (n =110). TVR: target lesion revascularization; TLR: target vessel revascularization;UA: unstable angina; CISR: clinical in-stent restenosis; Performed Tx: performedtreatment; CAGB: coronary bypass surgery; Balloon PCI: balloon percutaneouscoronary intervention.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4495452&req=5

f04: Kaplan-Meier curve for TVR, TLR and UA according to the treatment of CISR (n =110). TVR: target lesion revascularization; TLR: target vessel revascularization;UA: unstable angina; CISR: clinical in-stent restenosis; Performed Tx: performedtreatment; CAGB: coronary bypass surgery; Balloon PCI: balloon percutaneouscoronary intervention.
Mentions: As for the secondary outcome, univariate analysis identified clinical treatment of CISR(HR = 6.46; 95% CI 1.22–34.00; p = 0.028) and treatment of CISR with a BMS (HR = 4.18;95% CI 1.46–11.89; p = 0.007). These factors remained as independent predictors in themultivariate analysis of the risk of the combined outcome of UA with readmission, TVRand TLR, clinical treatment of CISR (HR = 6.29; 95% CI 1.35–29.38; p = 0.019) andtreatment of CISR with implantation of a BMS (HR = 4.08; 95% CI 1.75–9.48; p = 0.001;Table 4; Graph4).

Bottom Line: Twenty-four patients presented a secondary outcome.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.Patients with CISR present in most cases with ACS and with a high frequency of adverse events during a medium-term follow-up.

View Article: PubMed Central - PubMed

Affiliation: Programa de Pós-Graduação em Ciências da Saúde do Adulto, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil.

ABSTRACT

Background: Clinical in-stent restenosis (CISR) is the main limitation of coronary angioplasty with stent implantation.

Objective: Describe the clinical and angiographic characteristics of CISR and the outcomes over a minimum follow-up of 12 months after its diagnosis and treatment.

Methods: We 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.

Results: Mean 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.

Conclusion: Patients with CISR present in most cases with ACS and with a high frequency of adverse events during a medium-term follow-up.

Show MeSH
Related in: MedlinePlus