Long-term clinical follow-up of drug-eluting stent restenosis treatment: retrospective analysis from two high volume catheterisation laboratories

Aims: To evaluate clinical outcome of patients undergoing repeated percutaneous coronary intervention (PCI) for drug-eluting stent (DES) restenosis. Methods and results: We identified 213 patients who underwent re-PCI for DES restenosis. The study population was divided in two groups according to the treatment strategy: 94 patients were treated with at least one repeat DES implantation (DES-sandwich group); 119 patients were treated with balloon angioplasty alone (BA group). Diffuse pattern of restenosis was more frequent in DES-sandwich group (34.0% vs. 17.6%; P=0.006). During a median follow-up of 20.2 months (interquartile range 13.7 to 30.1), the incidence of cardiac death was 6.5% in the DES-sandwich and 2.5% in the BA group (P=0.18), the incidence of myocardial infarction 6.5% and 0.8% (P=0.04), and the incidence of TLR 13% and 10.9% (P=0.63), respectively. After adjustment for angiographic characteristics, DES-sandwich strategy tended to be associated with a higher rate of myocardial infarction (OR 8.2, 95%Cls[0.9-69.6]; P=0.05). By multivariate analysis, early and diffuse pattern of restenosis were found as predictors of adverse outcome at follow-up (OR 4.7, 95%CI[2.2-9.6], P<0.001; OR 2.3, 95%CI[1.1-4.8], P=0.02, respectively). Conclusions: A default strategy of repeat DES implantation does not seem to be advantageous and could be associated with a higher rate of myocardial infarction.