LONG-TERM CLINICAL FOLLOW-UP AFTER SUCCESSFUL REPEAT PERCUTANEOUS INTERVENTION FOR STENT RESTENOSIS

Objectives. This study evaluated the long-term clinical outcome of suc cessful repeat percutaneous intervention after in-stent restenosis. Ba ckground. Recurrence of symptoms and angiographic restenosis after ste nt implantation are observed in 15% to 35% of cases. Repeat percutaneo us treatment for in-stent restenosis has been shown to be safe, with h igh immediate success, but little is known about the long-term clinica l outcome. Methods. Clinical follow up (minimum 9 months) was obtained in a consecutive series of 124 patients (127 vessels) presenting with stent restenosis who were successfully treated with repeat percutaneo us intervention. Results. Clinical follow-up was obtained in all 124 p atients at a mean [+/-SD] of 27.4 +/- 14.7 months (range 9 to 66); a s tress test was available in 88 patients (71%). Recurrence of clinical events occurred in 25 patients (20%) and included death from any cause in 2 patients (2%), target vessel revascularization in 14 (11%), myoc ardial infarction in 1 (1%) and positive stress test results or recurr ence of symptoms (Canadian Cardiovascular Society class I to IV) treat ed medically in 8 (6%). Cumulative event-free survival at 12 and 24 mo nths was 86.2% and 80.7%, respectively, Significant predictive factors of recurrence of clinical events were repeat intervention in saphenou s vein grafts, multivessel disease, low ejection fraction and a less t han or equal to 3 month interval between stent implantation and repeat intervention. Conclusions. In-stent balloon angioplasty for stent res tenosis in native vessels seems to be an effective method in terms of a low long-term clinical event rate. (C) 1997 by the American College of Cardiology.