Prompt treatment negates restenosis impact
MedWire News: Results from a Korean study show that almost one-fifth of patients who receive drug-eluting stents (DES) for unprotected left main coronary artery (LMCA) disease experience in-stent restenosis (ISR).
However, ISR does not appear to increase the risk for adverse outcomes, such as death or myocardial infarction (MI), among such patients.
This finding, say Seung-Jung Park (University of Ulsan College of Medicine, Seoul) and team, is most likely related to the prompt optimal treatment given to the study participants who developed ISR.
The authors report that during a 32-month follow-up of 402 patients with DES-treated LMCA disease, no patients died, 2.2% had a MI, and 9.5% required revascularization.
After stenting, all patients underwent "meticulous clinical follow-up," which included routine surveillance or clinically-driven angiography performed according to the treating physician's clinical judgement.
In all, 17.7% of patients developed ISR and were subsequently treated medically (29.6%), by repeat stenting (56.3%), or by coronary artery bypass graft surgery (CABG; 14.1%).
Writing in the Journal of the American College of Cardiology, Park et al report that the development of ISR did not significantly associate with death or MI risk.
Furthermore, the risk for adverse cardiac events (composite of death, MI, or revascularization) was similar among all ISR patients, irrespective of the mode by which the restenosis was treated, at 14.4%, 13.6%, and 10.0% in the medical, stenting, and CABG groups, respectively.
Since the choice of post-ISR intervention was made at the discretion of the treating physician, the authors say that this finding illustrates that "treating physicians exercised excellent clinical judgement, choosing appropriate treatment method on the basis of knowledge of the co-existing conditions of their patients."
Park and team conclude that although their findings suggest that routine surveillance angiography may be beneficial in LMCA-ISR, further study is required.
They call for "large scale studies comparing routine and repeat follow-up angiography with non-invasive, functional follow-up after LMCA stenting."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Lauretta Ihonor