Long-term follow-up after deferring angioplasty in asymptomatic patients with moderate noncritical in-stent restenosis

Background: Many patients with in-stent restenosis (ISR) are angina-free, but the optimal treatment for these patients remains uncertain. Hypothesis: In cases with asymptomatic moderate noncritical ISR, deferral of the intervention may be safe and associated with favorable clinical outcome. Methods: We evaluated the long-term clinical outcome of asymptomatic patients (Group 1, n = 98) with moderate non-critical ISR (< 70% diameter stenosis) after intervention was deferred, and compared it with that of patients (Group 2, n = 655) without restenosis. After repeat angioplasty was deferred, all patients were treated medically and later underwent angioplasty only in the case of clinical recurrence. Results: Baseline characteristics were similar between the two groups. Clinical follow-up was available in all patients at 26.3 ± 15.9 months. Twenty patients died during the follow-up: I in Group 1 and 19 in Group 2. Target lesion revascularization was performed in 3 patients in Group 1 and 11 patients in Group 2 during follow-up (p = NS), and new lesion revascularization in 2 patients in Group 1 and 27 patients in Group 2 (p = NS). Event-free survival rate (cardiac death, nonfatal myocardial infarction, repeat revascularization) was 86.7 ± 6.1% in Group 1 and 84.8 ± 2.2% in Group 2 at the end of follow-up (p = NS). Major adverse cardiac events were only associated with the presence of diabetic mellitus (hazards ratio 2.65, 95% confidence interval [CI] 1.48-4.73, p < 0.01). The percentage of patients receiving antianginal medication was similar between the two groups at the end of the study (p = NS). Conclusions: Asymptomatic patients with moderate non-critical ISR have a good prognosis and similar clinical outcome as those without ISR, suggesting that it may be safe to defer repeat angioplasty in these patients until angina recurrence.