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Updated: Jun 9, 2025
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Comparison of Outcome After Percutaneous Coronary Intervention for De Novo and In-Stent Restenosis Indications
Lars Jakobsen1, Evald H Christiansen1, Phillip Freeman2
1Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Insights
Percutaneous coronary intervention (PCI) for in-stent restenosis (ISR) showed similar major adverse cardiac events (MACE) but a higher risk of target lesion revascularization (TLR) compared to de novo lesions after five years.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- In-stent restenosis (ISR) remains a complication following percutaneous coronary intervention (PCI).
- Comparative outcome data between PCI for de novo lesions and ISR are limited and conflicting.
- Understanding these differences is crucial for optimizing patient management after PCI.
Purpose of the Study:
- To compare the 5-year clinical outcomes of PCI for ISR versus de novo coronary lesions.
- To evaluate differences in major adverse cardiac events (MACE) and target lesion revascularization (TLR) between the two groups.
Main Methods:
- Analysis of patient-level data from the SORT OUT III to X randomized trials.
- Inclusion of patients with prior PCI treated for either ISR or de novo lesions.
- Comparison of MACE and TLR rates at 5-year follow-up using adjusted hazard ratios.
Main Results:
- A total of 2,928 patients were analyzed; 491 (17%) for ISR and 2,437 (83%) for de novo lesions.
- No significant difference in 5-year MACE rates between ISR and de novo groups (aHR 1.16; 95% CI 0.97-1.38).
- Significantly higher 5-year TLR risk in the ISR group compared to the de novo group (aHR 1.71; 95% CI 1.27-2.30).
Conclusions:
- PCI for ISR and de novo lesions yield similar rates of MACE at 5 years.
- PCI for ISR is associated with an increased risk of repeat revascularization (TLR) compared to de novo lesions.
- These findings highlight the need for careful consideration of revascularization strategies in patients with ISR.
Abstract:
In-stent restenosis (ISR) still occurs after percutaneous coronary intervention (PCI). Few studies have compared the outcomes of PCI for de novo stenosis with those of PCI for ISR, and the results are conflicting. The present study aimed to conduct this comparison. Using patient-level data from the randomized all-comer SORT OUT studies III to 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 2,928 patients with a previous PCI included in the SORT OUT studies, 491 (17%) were treated for ISR and 2,437 (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 654 patients (28%) in the de novo stenosis group (crude and adjusted hazard ratio 1.16 [95% confidence interval (CI) 0.97 to 1.38] and 1.16 [95% CI 0.97 to 1.38]). The risk of TLR was higher in the ISR group compared with the de novo stenosis group (crude and adjusted hazard ratio 1.64 [95% CI 1.24 to 2.17] and 1.71 [95% CI 1.27 to 2.30]). In conclusion, the risk of MACE was similar between PCI for ISR and PCI for de novo lesions after 5 years. However, the risk of TLR was higher in the ISR group compared with the de novo stenosis group.
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