Long-term outcomes of percutaneous coronary intervention for in-stent restenosis among Medicare beneficiaries

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Health Outcomes Research

Background:

• In-stent restenosis (ISR) is a frequent complication following percutaneous coronary intervention (PCI), often necessitating repeat revascularization.
• The long-term health implications and outcomes associated with ISR remain incompletely understood.

Purpose of the Study:

• To evaluate and compare the long-term clinical outcomes of patients who underwent PCI for ISR versus those who underwent PCI for de novo coronary lesions.
• Assess the rates of major adverse cardiovascular and cerebrovascular events (MACCE) in these patient groups.

Main Methods:

• Utilized National Cardiovascular Data Registry CathPCI data linked with Medicare claims for patients aged ≥65 years undergoing PCI between July 2009 and December 2014.
• Compared baseline characteristics and long-term incidences of death, myocardial infarction (MI), repeat revascularization (including target vessel revascularization - TVR), and MACCE between ISR PCI and de novo lesion PCI cohorts.

Main Results:

• Out of 653,304 individuals, 10.2% had ISR PCI and 89.8% had de novo lesion PCI. ISR PCI was associated with significantly higher rates of MACCE (55.6% vs 45.0%), all-cause mortality (27.8% vs 25.5%), MI (19.0% vs 12.3%), repeat revascularization (31.9% vs 18.6%), and TVR (22.4% vs 8.0%).
• Multivariable analysis confirmed ISR PCI independently predicted worse long-term outcomes, including a 24% higher risk of MACCE (HR 1.24) and a 2.5 times higher risk of TVR (HR 2.50).

Conclusions:

• Percutaneous coronary intervention for in-stent restenosis is prevalent and significantly increases the risk of recurrent major ischemic events compared to PCI for de novo lesions.
• Novel therapeutic strategies are crucial to mitigate the occurrence and impact of in-stent restenosis.