In-stent restenosis of drug-eluting stents: clinical presentation and outcomes in a real-world scenario

Ganesh Paramasivam, Tom Devasia, Shabeer Ubaid, Ashwitha Shetty, Krishnananda Nayak, Umesh Pai, Mugula Sudhakar Rao

Research output: Contribution to journalArticle

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.

Original languageEnglish
Article number28
JournalEgyptian Heart Journal
Volume71
Issue number1
DOIs
Publication statusPublished - 01-12-2019

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Drug-Eluting Stents
Acute Coronary Syndrome
Stents
Confidence Intervals
Chronic Renal Insufficiency
Odds Ratio
Myocardial Infarction
Percutaneous Coronary Intervention
Medical Records
Retrospective Studies
Incidence

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

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title = "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 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.",
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In-stent restenosis of drug-eluting stents : clinical presentation and outcomes in a real-world scenario. / Paramasivam, Ganesh; Devasia, Tom; Ubaid, Shabeer; Shetty, Ashwitha; Nayak, Krishnananda; Pai, Umesh; Rao, Mugula Sudhakar.

In: Egyptian Heart Journal, Vol. 71, No. 1, 28, 01.12.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - In-stent restenosis of drug-eluting stents

T2 - clinical presentation and outcomes in a real-world scenario

AU - Paramasivam, Ganesh

AU - Devasia, Tom

AU - Ubaid, Shabeer

AU - Shetty, Ashwitha

AU - Nayak, Krishnananda

AU - Pai, Umesh

AU - Rao, Mugula Sudhakar

PY - 2019/12/1

Y1 - 2019/12/1

N2 - 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.

AB - 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.

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