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

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.