Incidence, procedural management, and clinical outcomes of coronary in-stent restenosis: Insights from the National VA CART Program

Abstract Purpose Major disadvantages of the percutaneous coronary intervention (PCI) are the high occurrence of repeat revascularization due to restenosis and disease progression. The current study aimed to identify indicators that can predict the risk of repeat revascularization. Methods A total of 143 patients who underwent PCI and had genetic test results were enrolled. We retrospectively reviewed their medical records after the first PCI. P2Y12 reaction units (PRU) test results were obtained by VerifyNow; 372 SNPs of NOS3, MMP3, AGT, and AGT1R gene and 380 genes related to platelet activation-related processes and clopidogrel activity were selected for analysis. Repeat revascularization and in-stent restenosis (ISR) were used as clinical outcomes, and PRU and ADP aggregation rates were used as platelet function outcomes in analysis. Results After the first PCI, the incidence of repeat revascularization at 18, 30, and 42 months was 14.1% (20/142), 17.5% (24/137), and 39.7% (31/78), respectively. In the candidate gene analysis, Rs 78830 (NOS3) was associated with both ADP aggregation rate and 18- and 30-month ISR, and rs 62275847 (AGTR1) was associated with both ADP aggregation rate and 30-month ISR. In the pathway, gene-set analysis, the linkage rs471683 and rs7785386 of GNAI1|GNAT3 were associated with PRU and ADP aggregation rate, 18-months and 30-months ISR, and repeat revascularization within 30 months. Rs1715389 of GNAI1|GNAT3 were associated with both PRU and ADP aggregation rate, 18-months and 30-months ISR, and repeat revascularization within 30 months. Rs7313458 of ITPR2 were associated with PRU and ADP aggregation rate, 18-months and 30-months ISR, and repeat revascularization within 18 months. Conclusions The genetic polymorphisms of rs78830(NOS3), rs62275874 (AGTR1), linkage rs471683 and rs7785386 (GNAI1|GNAT3), rs1715389(GNAI1|GNAT3), and rs7313458 (ITPR2) may lead to an increased risk of in-stent restenosis and revascularization after the first PCI in Chinese patients by affecting the efficacy of clopidogrel. The above six SNP may be used as potential genetic biomarkers for high risk of in-stent restenosis and revascularization after the first PCI in Chinese patients.

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IMPACT OF ANGIOGRAPHIC PATTERNS OF IN-STENT RESTENOSIS ON LONG-TERM CLINICAL OUTCOMES IN PATIENTS TREATED WITH COBALT-CHROMIUM EVEROLIMUS-ELUTING STENT

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(20)31995-1 ◽

2020 ◽

Vol 75 (11) ◽

pp. 1368

Author(s):

Takashi Hiromasa ◽

Shoichi Kuramitsu ◽

Seiichi Hiramori ◽

Kyohei Yamaji ◽

Takenori Domei ◽

...

Keyword(s):

Clinical Outcomes ◽

Cobalt Chromium ◽

Stent Restenosis ◽

In Stent Restenosis

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Efficacy of Sr-90 beta radiation for the treatment of in-stent restenosis: 24-month clinical outcomes from the STents and Radiation Therapy Trial (START)

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(02)80197-8 ◽

2002 ◽

Vol 39 ◽

pp. 46

Author(s):

Warren K. Laskey ◽

Mohan Suntharalingam ◽

Jeffrey Popma ◽

Richard Heuser ◽

Barry Rutherford ◽

...

Keyword(s):

Radiation Therapy ◽

Clinical Outcomes ◽

Beta Radiation ◽

Stent Restenosis ◽

Therapy Trial ◽

In Stent Restenosis

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Comparison of clinical outcomes of two different types of paclitaxel-coated balloons for treatment of patients with coronary in-stent restenosis

Heart and Vessels ◽

10.1007/s00380-019-01388-z ◽

2019 ◽

Vol 34 (9) ◽

pp. 1420-1428 ◽

Cited By ~ 2

Author(s):

Viet Phuong Thuy Nguyen ◽

Choongki Kim ◽

Sung-Jin Hong ◽

Chul-Min Ahn ◽

Jung-Sun Kim ◽

...

Keyword(s):

Clinical Outcomes ◽

Stent Restenosis ◽

Different Types ◽

In Stent Restenosis

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Clinical Outcomes of Drug-Eluting versus Bare-Metal In-Stent Restenosis after the Treatment of Drug-Eluting Stent or Drug-Eluting Balloon: A Systematic Review and Meta-Analysis

Journal of Interventional Cardiology ◽

10.1155/2020/8179849 ◽

2020 ◽

Vol 2020 ◽

pp. 1-11

Author(s):

Yi-Xing Yang ◽

Yin Liu ◽

Chang-Ping Li ◽

Peng-Ju Lu ◽

Jiao Wang ◽

...

Keyword(s):

Clinical Outcomes ◽

Meta Analysis ◽

Cochrane Library ◽

Bare Metal ◽

Stent Restenosis ◽

Positive Prevention ◽

Drug Eluting ◽

Drug Eluting Balloon ◽

In Stent Restenosis

Background. Although drug-eluting stents (DES) have reduced the rates of in-stent restenosis (ISR) compared with bare-metal stents (BMS), DES related ISR (DES-ISR) still occurs and outcomes of DES-ISR remain unclear. The objective of this meta-analysis was to investigate the long-term clinical outcomes of patients with DES-ISR compared with patients with BMS related ISR (BMS-ISR) after the treatment of DES or drug-eluting balloon (DEB). Methods and results. We searched the literature in the main electronic databases including PUBMED, EMBASE, Cochrane Library, and Web of Science. The primary endpoints were target lesion revascularization (TLR) and target vessel revascularization (TVR). The secondary endpoints included all cause death (ACD), cardiac death (CD), myocardial infarction (MI), stent thrombosis or re-in-stent restenosis (ST/RE-ISR), and major adverse cardiovascular events (MACEs). A total of 19 studies with 6256 participants were finally included in this meta-analysis. Results showed that the rates of TLR (P<0.00001), TVR (P<0.00001), CD (P=0.02), ST/RE-ISR (P<0.00001), and MACEs (P<0.00001) were significantly higher in the DES-ISR group than in the BMS-ISR group. No significant differences were found between the two groups in the rates of MI (P=0.05) and ACD (P=0.21). Conclusions. Our study demonstrated that patients with DES-ISR had worse clinical outcomes at the long-term follow-up than patients with BMS-ISR after the treatment of DES or DEB, suggesting that DES and DEB may be more effective for BMS-ISR than that for DES-ISR. Positive prevention of DES-ISR is indispensable and further studies concentrating on detecting the predictors of outcomes of DES-ISR are required.

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