Age-related ten-year outcomes after percutaneous coronary intervention of in-stent restenosis

Older patients are often underrepresented in clinical trials investigating the treatment of coronary drug-eluting stent (DES) restenosis, but outcome data is urgently needed in an ageing society. Thus, the aim of this observational, retrospective study was to close this lack of evidence.

Between January 2007 and February 2021, 3511 patients with 5497 in-stent restenosis (ISR) lesions were treated at two large-volume centers in Munich, Germany. We compared the rates of cardiac death, myocardial infarction (MI) and repeat revascularization in 1105 patients (31.5 %) older than 75 years with 2406 patients (68.5 %) younger than 75 years. Survival was analyzed using the Kaplan-Meier method. Differences between the groups were tested with the log-rank test. Conventional multivariable analysis with adjustment for relevant variables was performed.

Older patients were more frequently female (30.1 % vs. 17.9 %, p < 0.001) and presented less frequently with stable angina (67.8 % vs. 72.0 %, p < 0.001). After 10 years, the rates of cardiac death were 56.8 % in older patients and 27.4 % in younger patients (HR_adj, 2.45 [95 % CI, 2.09-2.88], p < 0.001). Accounting for the risk of death, no difference was found regarding the rates of MI while target lesion revascularization (TLR) occurred less frequently in older patients (24.2 % vs. 33.7 %; HR_adj, 0.77 [95 % CI, 0.66-0.89], p < 0.001).

In the long-term, rates of cardiac death after percutaneous coronary intervention of DES-ISR were higher and TLR rates were lower in patients older than 75 years. There was no difference in the rates of MI.