In-stent restenosis of drug-eluting stents: clinical presentation and outcomes in a real-world scenario
Abstract Background Drug-eluting stents (DES) have substantially reduced the incidence of coronary in-stent restenosis (ISR), but the problem persists. Clinical presentation and outcomes of DES-ISR in a real-world scenario remains underreported. Results In this retrospective study, we examined medic...
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doaj-840296ee435246609f68d3435f416e9c2020-11-25T01:54:20ZengSpringerOpenThe Egyptian Heart Journal2090-911X2019-11-0171111010.1186/s43044-019-0025-zIn-stent restenosis of drug-eluting stents: clinical presentation and outcomes in a real-world scenarioGanesh Paramasivam0Tom Devasia1Shabeer Ubaid2Ashwitha Shetty3Krishnananda Nayak4Umesh Pai5Mugula Sudhakar Rao6Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher EducationDepartment of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher EducationDepartment of Cardiovascular Technology, School of Allied Health Sciences, Manipal Academy of Higher EducationDepartment of Cardiovascular Technology, School of Allied Health Sciences, Manipal Academy of Higher EducationDepartment of Cardiovascular Technology, School of Allied Health Sciences, Manipal Academy of Higher EducationDepartment of Cardiovascular Technology, School of Allied Health Sciences, Manipal Academy of Higher EducationDepartment of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher EducationAbstract Background Drug-eluting stents (DES) have substantially reduced the incidence of coronary in-stent restenosis (ISR), but the problem persists. Clinical presentation and outcomes of DES-ISR in a real-world scenario remains underreported. Results In this retrospective study, we examined medical records of 191 consecutive patients with DES-ISR (210 ISR lesions) hospitalized between January 2013 and December 2017. ISR clinical presentation was classified as acute coronary syndrome (ACS) or non-ACS. Clinical, angiographic features and 1-year outcomes [composite of death, myocardial infarction (MI) and repeat-target lesion revascularization] for these two groups were compared. The mean age of study population was 61 ± 10 years and 81.2% were males. ACS was the dominant clinical presentation mode occurring in 118 (61.8%) patients. MI was seen in 66 (34.6%) patients. Female gender (odds ratio, 2.71; 95% confidence interval [CI], 1.13–6.52; P = 0.026) and chronic kidney disease (odds ratio, 3.85; 95% CI, 1.05–14.20; P = 0.043) correlated significantly with ACS ISR presentation. A majority [104 (54.5%)] of patients underwent percutaneous coronary intervention (PCI), of whom 72 (69.2%) received a new DES. The rest either underwent CABG (26.2%) or received medical therapy (19.4%). Patients presenting with ACS had a significantly worse clinical outcome at 1-year follow-up (ACS versus non-ACS presentation: hazard ratio [HR], 2.66; 95% CI, 1.09–6.50; P = 0.032). Conclusions DES-ISR presents most commonly as ACS. Female gender and chronic kidney disease seem to be associated with ACS presentation. ACS presentation of ISR is associated with worse 1-year outcomes. Early identification of those with ACS risk and closer follow-up may improve outcomes.http://link.springer.com/article/10.1186/s43044-019-0025-zIn-stent restenosisDrug-eluting stentPercutaneous coronary intervention |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ganesh Paramasivam Tom Devasia Shabeer Ubaid Ashwitha Shetty Krishnananda Nayak Umesh Pai Mugula Sudhakar Rao |
spellingShingle |
Ganesh Paramasivam Tom Devasia Shabeer Ubaid Ashwitha Shetty Krishnananda Nayak Umesh Pai Mugula Sudhakar Rao In-stent restenosis of drug-eluting stents: clinical presentation and outcomes in a real-world scenario The Egyptian Heart Journal In-stent restenosis Drug-eluting stent Percutaneous coronary intervention |
author_facet |
Ganesh Paramasivam Tom Devasia Shabeer Ubaid Ashwitha Shetty Krishnananda Nayak Umesh Pai Mugula Sudhakar Rao |
author_sort |
Ganesh Paramasivam |
title |
In-stent restenosis of drug-eluting stents: clinical presentation and outcomes in a real-world scenario |
title_short |
In-stent restenosis of drug-eluting stents: clinical presentation and outcomes in a real-world scenario |
title_full |
In-stent restenosis of drug-eluting stents: clinical presentation and outcomes in a real-world scenario |
title_fullStr |
In-stent restenosis of drug-eluting stents: clinical presentation and outcomes in a real-world scenario |
title_full_unstemmed |
In-stent restenosis of drug-eluting stents: clinical presentation and outcomes in a real-world scenario |
title_sort |
in-stent restenosis of drug-eluting stents: clinical presentation and outcomes in a real-world scenario |
publisher |
SpringerOpen |
series |
The Egyptian Heart Journal |
issn |
2090-911X |
publishDate |
2019-11-01 |
description |
Abstract Background Drug-eluting stents (DES) have substantially reduced the incidence of coronary in-stent restenosis (ISR), but the problem persists. Clinical presentation and outcomes of DES-ISR in a real-world scenario remains underreported. Results In this retrospective study, we examined medical records of 191 consecutive patients with DES-ISR (210 ISR lesions) hospitalized between January 2013 and December 2017. ISR clinical presentation was classified as acute coronary syndrome (ACS) or non-ACS. Clinical, angiographic features and 1-year outcomes [composite of death, myocardial infarction (MI) and repeat-target lesion revascularization] for these two groups were compared. The mean age of study population was 61 ± 10 years and 81.2% were males. ACS was the dominant clinical presentation mode occurring in 118 (61.8%) patients. MI was seen in 66 (34.6%) patients. Female gender (odds ratio, 2.71; 95% confidence interval [CI], 1.13–6.52; P = 0.026) and chronic kidney disease (odds ratio, 3.85; 95% CI, 1.05–14.20; P = 0.043) correlated significantly with ACS ISR presentation. A majority [104 (54.5%)] of patients underwent percutaneous coronary intervention (PCI), of whom 72 (69.2%) received a new DES. The rest either underwent CABG (26.2%) or received medical therapy (19.4%). Patients presenting with ACS had a significantly worse clinical outcome at 1-year follow-up (ACS versus non-ACS presentation: hazard ratio [HR], 2.66; 95% CI, 1.09–6.50; P = 0.032). Conclusions DES-ISR presents most commonly as ACS. Female gender and chronic kidney disease seem to be associated with ACS presentation. ACS presentation of ISR is associated with worse 1-year outcomes. Early identification of those with ACS risk and closer follow-up may improve outcomes. |
topic |
In-stent restenosis Drug-eluting stent Percutaneous coronary intervention |
url |
http://link.springer.com/article/10.1186/s43044-019-0025-z |
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