Risk factors for early and late restenosis after secondary DES implantation identified
medwireNews: Early and late restenosis events occur after secondary drug-eluting stent (DES) implantation among patients undergoing revascularization due to DES restenosis, with the risk factors for restenosis varying depending on the period of time after the procedure, researchers report.
In a retrospective analysis, the study authors found that recurrent restenosis occurred in 25.8% of 359 lesions among patients undergoing first-generation DES implantation and in 24.5% of 329 lesions among those undergoing second-generation DES implantation after a median 246 days of follow-up. Rates of late restenosis were 15.8% and 14.7%, respectively, after a median 613 days of follow-up.
Therefore, “[t]wo-year serial clinical follow-up and angiographic follow-up after intervention for DES restenosis might be needed,” study authors Seiji Habara (Kurashiki Central Hospital, Okayama, Japan) and colleagues write in Circulation: Cardiovascular Interventions.
Nonfocal-type restenosis was identified as a significant predictor of both early and late restenosis in multivariable analysis, with odds ratios of 2.98 and 3.40, respectively. However, other predictors of early stenosis, including percentage diameter stenosis after the procedure, previous stent size, and right coronary artery ostial lesion, were not significantly associated with late restenosis. Similarly, stent fracture was a significant predictor of late restenosis, but not early restenosis.
The authors note that nonfocal-type restenosis “may be related to drug failure,” with repeat stenting potentially leading “to an uneven distribution of drug release and suboptimal stent geometry.”
“The use of a [paclitaxel-coated balloon] may be more favorable in nonfocal-type lesions, in which multiple stent layers with a long length should be avoided,” they add.
Overall, the study included data from 608 patients with 688 lesions. A total of 85.2% had stable angina at baseline, whereas 14.8% had an acute coronary syndrome. Among 323 patients who underwent first-generation DES implantation for restenosis, 50.4% received a sirolimus-eluting stent, 44.9% received a paclitaxel-eluting stent, and 4.7% a zirolimus-eluting stent. Second-generation DES included cobalt–chromium everolimus-, biolimus-, platinum–chromium everolimus-, and zotarolimus-eluting stents (given to 64.7%, 24.3%, 9.4%, and 1.5% of 285 participants, respectively).
There was no significant difference in the cumulative incidence of target lesion revascularization, major adverse cardiac events, and a composite of cardiac death, myocardial infarction, or stent thrombosis at 24 months between patients receiving first- versus second-generation DES. However, the incidence of these events was numerically higher with first-generation DES, with corresponding rates of 28.1% versus 21.5%, 31.6% versus 25.7%, and 4.8% versus 2.3%.
The authors caution that their retrospective single-center study has “several limitations,” including selection bias and lack of imaging analysis using optical coherence tomography.
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