Early and late restenosis of drug-eluting stents: an observational study about predictors, clinical presentation and response to treatment (the LATE DES study)

Flavia Belloni, Francesco Fracassi, et al
AsiaIntervention 2017;3:131-138, DOI: 10.4244/AIJ-D-16-00021

Abstract
Aims: The aim of the study was to evaluate differences in clinical presentation, angiographic and clinical predictors, and response to treatment of early (<9 months) vs. late (≥9 months) in-stent restenosis (ISR) of drug-eluting stents (DES).

Methods and results: One hundred and twenty-nine patients with DES restenosis (defined by angiography as diameter stenosis >50% at the stent segment or its edges) were enrolled: 79 (61%) had early DES restenosis (6±2 months) and 50 (39%) late DES restenosis (18±8 months). ISR treatment strategy was left to the operator’s choice: DES or drug-eluting balloon (DEB). The primary endpoint was the incidence of major adverse cardiovascular events (MACE) at follow-up. Patients with early DES restenosis more frequently had an acute coronary syndrome as clinical presentation at the index procedure as compared to those with late DES restenosis (OR 2.63, 95% CI: 1.12-6.25; p=0.027). The treatment of DES restenosis was DES implantation in 78 (60%) patients and DEB in 51 (40%) patients, without differences between early and late DES ISR. MACE after ISR treatment occurred in 25 (19%) patients, without differences between early and late DES ISR (16 [20%] vs. 9 [18%]; p=0.75, respectively). Diabetes mellitus was the only independent predictor of MACE at follow-up (OR 4.6, 95% CI: 1.3-19.3; p=0.03). MACE-free survival was similar after treatment in early or late ISR (p=0.097) and according to ISR treatment (p=0.73).

Conclusions: Early DES restenosis occurred more frequently after DES implantation for ACS compared with late DES restenosis. This, however, did not translate into a difference in MACE rate after ISR treatment at follow-up. Treatment choice for ISR did not affect prognosis. Diabetes mellitus remains the only independent predictor of MACE after treatment of DES ISR.

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