Everolimus-eluting stent (EES) is effective for treating in-stent restenosis (ISR). However, the long-term incidence of target lesion revascularization (TLR) is unknown. Further, the role of post-intervention minimal stent area (MSA) measured by intravascular ultrasound (IVUS) in TLR is unknown in this setting.
Overall, 223 ISR lesions (192 patients) that were treated with EES between 2010 and 2016 were analyzed retrospectively. Lesions were divided into two groups according to the post-intervention MSA [≤5.3 mm2: 72 lesions (67 patients), and >5.3 mm2: 151 lesions (138 patients)]. The cut-off point was determined on the basis of receiver operating characteristic curve analysis.
The cumulative 5-year incidence of TLR was significantly higher in the group with MSA of 5.3 mm2 or less than in the group with MSA more than 5.3 mm2 (15.8 and 7.2%, P=0.01). After adjusting for confounders, the excess risk of the group with MSA of 5.3 mm2 or less relative to the group with MSA more than 5.3 mm2 for TLR remained significant [hazard ratio: 3.07, 95% confidence interval (CI): 1.17–8.51, P=0.02]. Using multivariate logistic regression analysis, we identified female sex (odds ratio: 2.39, 95% CI: 1.06–5.49, P=0.04) and stent size of 3.0 mm or less (odds ratio: 13.43, 95% CI: 6.23–32.38, P<0.0001) as independent predictors of MSA of 5.3 mm2 or less.
EES implantation for ISR was associated with an acceptable rate of TLR through long-term follow-up. Post-intervention MSA of 5.3 mm2 or less was associated independently with a higher risk for TLR.
Departments of aCardiovascular Medicine
bCardiovascular Surgery, Koto Memorial Hospital, Shiga
cDepartment of Cardiovascular Medicine, Midorigaoka Hospital, Osaka
dDepartment of Clinical Epidemiology, Hyogo College of Medicine, Hyogo
eDepartment of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Correspondence to Takanari Fujita, MD, Department of Cardiovascular Medicine, Koto Memorial Hospital, 2-1 Hiramatsu-Cho, Higashiomi-Shi, Shiga 527-0134, Japan Tel: +81 749 45 5000; fax: +81 749 45 5001; e-mail: email@example.com
Received October 21, 2018
Received in revised form February 3, 2019
Accepted February 24, 2019