Incidence and predictors of recurrent restenosis following implantation of drug-eluting stents for in-stent restenosis

Objectives: We investigated the incidence and predictors of recurrent restenosis after drug-eluting stent (DES) implantation for in-stent restenosis (ISR) in routine clinical practice. Background: Although DESs have been increasingly used for treatment of ISR, little is known about the predictors of DES failure. Methods. We determined the incidence of recurrent restenosis and major adverse cardiac events (MACE) in 224 consecutive patients with 239 lesions treated with sirolimus-eluting (n = 217 lesions) or paclitaxel-eluting (n = 22 lesions) stents for the first episode of ISR. Results: The procedural success rate was 99.2%, and in-hospital complications did not occur in any patient. Follow-up angiography at 6 months was obtained in 73.7% of patients. Angiographic re-restenosis rate was 12.6%, and target lesion revascularization was required in 7.6% of patients. Of the 22 incidents of re-restenosis, 15 were focal (68.2%), 5 were diffuse (22.7%), and 2 were total (9.1%) restenosis. Univariate analysis showed that lesion length, use of paclitaxel-eluting stent, and number of stents per lesion were significant predictors of re-restenosis. In multivariate analysis, however, lesion length and use of paclitaxel-eluting stent were independent predictors of re-restenosis. During the follow-up (mean, 18.3 ± 8.1 months), there were 4 deaths (1 cardiac, 3 noncardiac), but no nonfatal myocardial infarctions (MIs). MACE occurred in 18 patients. The cumulative probability of MACE-free survival was 92.9 ± 1.8% at 1 year and 90.5 ± 2.4% at 2 years. Conclusions: DESs are highly effective for treatment of ISR, with recurrent restenosis related to lesion length and type of DES.