Prevalence, Predictors and Clinical Outcomes of Percutaneous Coronary Intervention For In-Stent Restenosis versus De Novo Coronary Artery Disease

IF 2.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology Pub Date : 2026-03-01 Epub Date: 2025-12-29 DOI:10.1016/j.amjcard.2025.11.027

Millie Watkins MBChB , Jacob Park MD , Diem Dinh PhD , Angela Brennan PhD , Riley Batchelor MBBS , Dion Stub PhD , Christopher Reid PhD , Anoop N. Koshy PhD , Jeffrey Lefkovits MD , Andrew J. Taylor PhD , Sinjini Biswas PhD , VCOR investigators

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引用次数: 0

Abstract

In-stent restenosis (ISR) remains a challenging complication following percutaneous coronary intervention (PCI), owing to its complex pathogenesis and multifaceted risk factor profile. We performed a retrospective analysis of all PCI data recorded in the Victorian Cardiac Outcomes Registry (VCOR), from 2013 to 2022, dividing patients into the ISR or de novo-PCI groups based on the intervened lesion. The primary outcome was in hospital mortality, with secondary outcomes including 30-day major adverse cardiovascular events and long-term mortality. Among 104,722 total PCI procedures, 4,935 procedures (4.7%) were for ISR, and 99,787 procedures (95.3%) were for de novo coronary lesions. Patients with ISR were older (mean age 69.0 ± 10.7 years vs. 66.4 ± 11.9 years, p < 0.001) with a higher burden of comorbidities including advanced chronic kidney disease (eGFR less than 31ml/min/1.73m² (4.2% vs. 2.5%, p < 0.001)), peripheral vascular disease (6.3% vs. 3.3%, p < 0.001) and diabetes mellitus (34.8% vs. 22.3%, p < 0.001). Lesion complexity was higher in the ISR group, with more lesions classified as ACC/AHA Type B2 and above (74.8% vs. 59.6%, p < 0.001). Adjunctive imaging devices were more commonly utilized in the ISR group; however, use was generally low (8.4% vs. 2.8%, p < 0.001). In-hospital mortality was lower in the ISR group, whereas 30-day target vessel and lesion revascularization rates were higher (1.3% vs. 0.7%, p < 0.001 and 0.8% vs. 0.4%, p = 0.001 respectively). Long term mortality as assessed over 10 years was higher in the ISR group. In conclusion, compared with de novo PCI, patients undergoing ISR PCI were older with greater comorbidities and lesion complexity. ISR PCI was associated with lower in-hospital mortality but worse long-term survival. These findings provide contemporary, population-based evidence on the evolving clinical profile and outcomes of ISR in routine PCI practice.

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经皮冠状动脉介入治疗支架内再狭窄与新发冠状动脉疾病的患病率、预测因素和临床结果

由于其复杂的发病机制和多方面的危险因素，支架内再狭窄（ISR）仍然是经皮冠状动脉介入治疗（PCI）后的一个具有挑战性的并发症。我们对2013年至2022年维多利亚州心脏结局登记处（VCOR）记录的所有PCI数据进行了回顾性分析，并根据介入病变将患者分为ISR组或新PCI组。主要结局是住院死亡率，次要结局包括30天主要不良心血管事件和长期死亡率。在总共104,722例PCI手术中，4935例（4.7%）为ISR， 99,787例（95.3%）为新发冠状动脉病变。ISR患者年龄较大（平均年龄69.0±10.7岁vs 66.4±11.9岁，p < 0.05）

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来源期刊

American Journal of Cardiology 医学-心血管系统

CiteScore

4.00

自引率

3.60%

发文量

698

审稿时长

33 days

期刊介绍： Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.