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Incidence, procedural management, and clinical outcomes of coronary in‐stent restenosis: Insights from the National VA CART Program
Author(s) -
Waldo Stephen W.,
O'Donnell Colin I.,
Prouse Andrew,
Plomondon Mary E.,
Rao Sunil V.,
Maddox Thomas M.,
Ho P. Michael,
Armstrong Ehrin J.
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27161
Subject(s) - medicine , restenosis , percutaneous coronary intervention , veterans affairs , cohort , incidence (geometry) , revascularization , propensity score matching , cardiology , stent , surgery , myocardial infarction , physics , optics
Backround In‐stent restenosis (ISR) remains a common clinical problem associated with significant morbidity. We sought to evaluate the temporal trends in incidence and procedural management of coronary restenosis as well as evaluate the association between different treatment modalities and clinical outcomes. Methods We identified all patients treated for coronary ISR within the Veterans Affairs Healthcare System from October 1, 2006 to September 30, 2014. The temporal trends in incidence as well as intraprocedural management were assessed. Among patients treated for single vessel restenosis, a propensity matched cohort was created for those treated with drug‐eluting stents (DES) or other treatment modalities. Target vessel revascularization (TVR) and mortality were compared between the two subpopulations. Results From 2006 to 2014, 65,443 patients underwent percutaneous coronary intervention and 6,872 patients (10.5%) with 8,921 lesions were treated for ISR. The proportion of patients undergoing revascularization for restenosis increased 0.28% per year ( P = 0.055). Among a propensity‐matched cohort of 6,231, the rates of TVR (subdistribution HR: 0.623, 95% CI: 0.511–0.760) and mortality (HR: 0.730, 95% CI: 0.641–0.830) were significantly lower among patients treated with a DES compared with other treatments. After adjustment for known risk factors, treatment with DES continued to be associated with a reduction in mortality rate (Adjusted HR: 0.802, 95% CI: 0.704–0.913). Conclusions There is a trend toward an increasing proportion of coronary interventions for ISR in a national cohort of Veterans and treatment with a DES is associated with the lowest rate of TVR and overall mortality.