Comparison of Outcome After Percutaneous Coronary Intervention for De Novo and In-Stent Restenosis Indications.

Abstract

In-stent restenosis (ISR) still occur after percutaneous coronary intervention (PCI). Few studies have compared outcomes after PCI for de novo stenosis and ISR and the results are conflicting. The aim of the present study is to compare outcomes after PCI for ISR and de novo coronary stenosis. Using patient level data from the randomized all-comer SORT OUT studies III-X, we included all patients with previous PCI and either an ISR or a de novo lesion as the study target lesion. Outcomes of interest were major adverse cardiac events (MACE) and target lesion revascularization (TLR) after 5 years. Of the 2928 patients with a previous PCI included in the SORT OUT studies, 491 (17%) were treated for ISR and 2437 (83%) for a de novo stenosis. Baseline characteristics did not differ significantly. At 5 years, MACE occurred in 148 patients (32%) in the ISR group and in 654 patients (28%) in the de novo stenosis group (Crude and adjusted HR 1.16 (0.97-1.38) and 1.16 (0.97-1.38)). The risk of TLR was higher in the ISR group when compared to the de novo stenosis group (Crude and adjusted HR 1.64 (95% CI, 1.24-2.17) and 1.71 (95% CI, 1.27-2.30)). In conclusion, the risk of MACE was similar after PCI of ISR and de novo lesions after 5 years. However, the risk of TLR was higher in the ISR group compared to the de novo stenosis group.