The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Long-Term Outcomes of In-Stent Restenosis Percutaneous Coronary Intervention among Medicare Beneficiaries

DOI: 10.4244/EIJ-D-19-01031

1. Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston,MA, USA
2. Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
3. Beth Israel Deaconess Medical Center, Medicine, Boston, MA, United States
4. Carle Health System; Carle Illinois College of Medicine; Beckman Institute for Advanced Science and Technology, University of Illinois, Urbana, IL, USA
5. Baim Institute for Clinical Research, Boston, MA, USA
6. Abiomed, Inc, Danvers, MA, USA
7. Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA.Baim Institute for Clinical Research, Boston, MA, USA
8. Richard A. and Susan F. Smith Centre for Cardiovascular Outcomes Research, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, medicine, United States
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Aims: This study evaluated the long-term outcomes of patients undergoing percutaneous coronary intervention (PCI) for in-stent restenosis (ISR).

Methods and Results: National Cardiovascular Data Registry CathPCI records for individuals aged ≥65 years undergoing PCI from July 2009-December 2014 were linked to Medicare claims. Baseline characteristics and long-term rates of death, myocardial infarction (MI), repeat revascularization including target vessel revascularization (TVR), and major adverse cardiovascular and cerebrovascular events (MACCE) were compared between ISR PCI versus de novo lesion PCI. Of 653,304 individuals, 10.2% underwent ISR PCI and 89.8% underwent de novo lesion PCI. The median duration of follow-up was 825 days (quartile 1: 352 days – quartile 3: 1379 days). Frequency of MACCE (55.6% vs. 45.0%; P<0.001), all-cause mortality (27.8% vs. 25.5%; P<0.001), MI (19.0% vs. 12.3%; P<0.001), repeat revascularization (31.9% vs. 18.6%; P<0.001), TVR (22.4% vs. 8.0%; P<0.001), and stroke (8.8% vs. 8.3%; P=0.005) were higher after ISR PCI. After multivariable adjustment, ISR PCI remained associated with worse long-term outcomes (hazard ratio [HR] for MACCE 1.24 [95% CI: 1.22, 1.26], mortality 1.07 [95% CI: 1.05, 1.09], MI 1.44 [95% CI: 1.40, 1.48], repeat revascularization 1.55 [95% CI: 1.51, 1.59], and TVR 2.50 [95% CI: 2.42, 2.58]).

Conclusions: ISR PCI was common and associated with significantly higher risk of recurrent long-term major ischemic events compared to patients undergoing de novo lesion PCI. There remains a need for new strategies to minimize ISR.

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