Long-term outcome after drug-eluting stents implantation: target lesion versus nontarget lesion repeated intervention

We sought to investigate the relative clinical significance of target and nontarget lesions repeated percutaneous coronary intervention (re-PCI) in patients implanted with drug-eluting stents (DES). Out of 2626 consecutive DES patients, we retrospectively selected 166 (6.3%; 123 males, aged 65±10 years) who had a clinically-driven re-PCI over a mean follow-up of 15 months. Seventy-five patients (45%) underwent the second procedure for disease progression in nontarget lesions (nontarget lesion re-PCI group) while 91 (55%) showed target lesion in-stent restenosis or thrombosis (target lesion re-PCI group), with no significant intergroup difference in the temporal trends of re-PCI. The prevalence of stable coronary artery disease and acute coronary syndromes (ACS) was 22% and 78% in the target lesion re-PCI vs. 81% and 19% in the nontarget lesion re-PCI group (overall p<0.001), respectively. In-stent restenosis accounted for 75% of second procedures in the target lesion re-PCI group and presented as an ACS in 72% of cases. The need for a new PCI in DES patients is relatively low in a real world setting. Stent-related events in the target lesion and progression of disease in nontarget lesions account to a similar extent for re-PCI, although their clinical presentation is strikingly different. The most common presentation of events related to previously treated lesions is an unstable syndrome, which provides support to the concept that also restenosis in a DES should not be considered a clinically benign entity.