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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Long-Term Outcomes After Management of Restenosis or Thrombosis of Drug-Eluting Stents

Gregory J. Mishkel, MD, FACC^_*,,, Anna L. Moore, MPH, Steve Markwell, MA, M. Coleman Shelton and Marc E. Shelton, MD, FACC^_*,,,_*

^_* Prairie Heart Institute at St. John's Hospital, Springfield, Illinois
Prairie Education & Research Cooperative, Springfield, Illinois
Southern Illinois University School of Medicine, Springfield, Illinois

Manuscript received February 1, 2006; revised manuscript received August 10, 2006, accepted August 15, 2006.

^_* Reprint requests and correspondence: Dr. Marc E. Shelton, Prairie Cardiovascular Consultants, Ltd., Prairie Heart Institute, P.O. Box 19420, Springfield, Illinois 62794. (Email: mshelton{at}prairieheart.com).

OBJECTIVES: The purpose of this study was to examine the outcomes of patients who developed coronary in-stent restenosis (ISR) or stent thrombosis (STH) inside drug-eluting stents (DES).

BACKGROUND: Drug-eluting stents have markedly reduced the incidence of restenosis. However, when restenosis occurs within a DES, its optimal management remains unclear.

METHODS: We retrospectively analyzed clinical and angiographic data from 92 patients who underwent revascularization for ISR (n = 84) or STH (n = 8) within a DES at our institution. Regular follow-ups were available up to 2 years. We recorded the occurrence of major adverse cardiac events (MACE), defined as deaths from all causes, myocardial infarction (MI), or target lesion revascularization (TLR), among patients treated by the "DES sandwich" technique or by other treatment methods.

RESULTS: In-hospital MACE included 1 periprocedural MI and 2 deaths. Over a mean follow-up of 15 ± 6 months, the overall rates of death, MI, and TLR were 8.7%, 2.2%, and 30.6%, respectively. By actuarial analysis, the 12-month TLR and MACE rates were 28.2% and 42.9%, respectively.

CONCLUSIONS: Current treatments of ISR or STH in DES are associated with a high long-term rate of MACE.

Abbreviations and Acronyms   BMS = bare-metal stent(ing)   DES = drug-eluting stents   ISR = in-stent restenosis   MACE = major adverse cardiovascular events   MI = myocardial infarction   PCI = percutaneous coronary intervention   STEMI = ST-segment elevation myocardial infarction   STH = stent thrombosis   TLR = target lesion revascularization

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