Letter by De Rosa and Indolfi Regarding Article, “Clinical Presentation and Outcomes of Coronary In-Stent Restenosis Across 3-Stent Generations”

Abstract

We read with interest the recently published study by Magalhaes et al1 on coronary in-stent restenosis (ISR) across 3 generations of metallic stents. The authors report unstable angina as being the clinical presentation of ISR in ≈60% of patients across all 3 stent generations, whereas acute myocardial infarction was the clinical presentation in as much as 9.8% of cases in the entire cohort. The authors also found that clinical presentation of ISR as an acute coronary syndrome is associated with a worse clinical outcome. One unproven hypothesis is the lower propensity of second-generation drug-eluting stent (DES) to develop a vulnerable neointima when compared with first-generation DES.2 The recently introduced bioresorbable scaffolds (BVS) yield the …