Aims: Due to the widespread use of drug-eluting stents (DES), in-DES restenosis is increasing. The aim of this study is to evaluate the clinical outcome of patients undergoing repeat percutaneous coronary intervention (PCI) for DES restenosis.
Methods and results: One hundred patients with 108 restenotic lesions using DES were consecutively enrolled in a single-arm 2-centre registry. The repeat-PCI was performed either with balloon angioplasty (POBA) or with DES implantation (homo-stent or hetero-stent). Major adverse cardiac events (MACE) occurrence was assessed long-term. Of the 108 DES restenotic lesions, 34 were treated with balloon angioplasty, 43 with homo-stent and 31 with hetero-stent implantation. Of the patients, 37% had diabetes mellitus, while 30% peripheral or carotid artery disease. Over a mean follow-up of 16.0+/-6.0 months, the rates of death, myocardial infarction (MI), and ischaemic driven target lesion revascularisation (IDTLR) in hetero-stent, homo-stent and POBA groups were respectively 0% vs. 5% vs. 3% (p=NS), 2% vs. 5% vs. 0% (p=NS) and 17% vs. 23% vs. 25% (p=NS). When comparing patients treated with POBA to those receiving hetero-/homo-DES, no significant difference in terms of IDTLR (25% vs. 20%; p=NS), MI (0% vs. 4%; p=NS) and overall MACE (25% vs. 23%, p=NS) appeared. The presence of previous MI (OR 0.05; 95% CI 0.01-0.3), first DES implanted for BMS restenosis (OR 0.16; 95% CI 0.02-0.99) and peripheral or carotid disease (OR 0.09; 95% CI 0.01-0.67) were negative independent predictors of freedom from IDTLR.
Conclusions: Repeat balloon angioplasty for DES restenosis showed similar clinical outcome compared to re-DES (homo- or hetero-) implantation and could be considered as first treatment strategy in this setting.