Abstract 3031: Repeat Revascularisation following Multivessel Sirolimus-eluting Stent Implantation: Indications and Long-term Follow-up From the Arterial Revascularisation Therapies Study Part 2 (ARTS-II)

Abstract

Objectives: Although coronary-artery bypass grafting (CABG) has been considered the gold standard of treatment for multivessel coronary artery disease, percutaneous coronary intervention (PCI) with drug-eluting stents (DES) may be an alternative: the ARTS-II trial found that after 3 years, the major benefit of CABG was a decreased need for repeat revascularization. We reviewed the angiographic findings in all patients from ARTS-II who required repeat revascularization to investigate their prognosis and to establish the reasons for repeat revascularization in these high risk complex patients, including the relative contributions of procedural complications, neointimal hyperplasia, stent thrombosis, geographical miss and disease progression. Methods: There was no routine angiographic follow-up in ARTS-II. All intercurrent angiograms within 3 years were reviewed. Patients requiring CABG due to index procedural complications or procedural failure were excluded (n = 8). The angiographic indications for repeat revascularization were categorized into target lesion revascularization (TLR), target vessel-non target lesion revascularization (TV-nonTLR) or non-target vessel revascularization (non-TVR). Patients undergoing TLR were further categorized into instent restenosis (ISR) according to the Mehran classification, stent edge restenosis (SER) or definite stent thrombosis (ST). Findings: Within 3 years of the initial treatment, 81/607 patients required 103 repeat revascularizations to treat 150 lesions. These repeat revascularizations were classified as TLR in 74% of lesions, TV-nonTLR in 22% and non-TVR in 4%. The cases of TLR were due to ISR in 59%, SER in 25% and ST in 17%. The majority of ISR cases were Mehran Class IC (focal, body). ISR accounted for 42% of all repeat revascularizations, whilst ST accounted for 11%. Conclusion: Repeat revascularization was due to ISR or ST in approximately half of the lesions; the remainder were due to either incomplete lesion coverage or disease progression. Hard clinical endpoint outcomes of patients stratified by the type of repeat revascularization will be presented at the meeting.