In-stent restenosis: Long-term outcome and predictors of subsequent targetlesion revascularization after repeat balloon angioplasty

OBJECTIVES We sought to evaluate the long-term clinical outcome of patients undergoing successful balloon angioplasty for in-stent restenosis, and to determine correlates of the need for subsequent target lesion revasculariza tion (TLR). BACKGROUND In-stent restenosis can be safely treated by repeat percutaneous intervention. Reported subsequent TLR rates have varied from 20% to 80% an d seem related to the type of restenotic lesion. METHODS The study population comprised 234 patients with follow-up data who were successfully treated with repeat balloon angioplasty for in-stent res tenosis in 257 lesions between May 1995 and January 1998 at our institution . RESULTS Clinical follow-up was available at 459 (286 to 693) days after the repeat procedure. Event-free survival was 78.5% and 74.6% at 12 and 24 mon ths, respectively. Recurrent events occurred in 58 patients (24.8%), includ ing 6 deaths (2.6%), 4 myocardial infarction (1.7%) and repeat target Vesse l revascularization in 50 patients (21.4%). Independent predictors of repea t TLR were time to in-stent restenosis <90 days (Hazard ratio 4.67, p < 0.0 01), minimal luminal diameter after repeat procedure (Hazard ratio 0.38, p = 0.034) and the angiographic pattern of in-stent restenosis (Hazard ratio 1.65, p = 0.036). CONCLUSION Balloon angioplasty is an effective means of treating in-stent r estenosis. The long-term results are acceptable particularly for focal rest enotic lesions. Further restenosis is more common in patients with early in itial recurrence, more proliferative lesions and a poorer angiographic resu lt from repeat angioplasty. (C) 2000 by the American College of Cardiology.