Percutaneous coronary intervention of lesions with in-stent restenosis

A report from the ADAPT-DES study

Björn Redfors, Philippe Genereux, Bernhard Witzenbichler, Akiko Maehara, Giora Weisz, Thomas McAndrew, Roxana Mehran, Ajay J. Kirtane, Gregg W. Stone

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: There is a paucity of data from large contemporary cohorts of patients with in-stent restenosis (ISR) treated with drug-eluting stents (DESs), and no studies have examined the impact of high platelet reactivity (HPR) on the occurrence of ischemic events after ISR percutaneous coronary intervention (PCI) with DESs. We sought to report outcomes after PCI of ISR lesions and its association with HPR. Methods: Patients in the prospective, multicenter ADAPT-DES study were stratified according to whether they had ISR versus non-ISR PCI. Two-year outcomes were compared between the groups using Cox proportional hazards models. HPR was defined as on-clopidogrel P2Y12 platelet reaction units >208 as measured by the VerifyNow assay; target vessel failure (TVF) was defined as the composite of all-cause death, myocardial infarction, or ischemia-driven target vessel revascularization. Results: Among the 8,582 patients included in the ADAPT-DES study, 840 (9.8%) patients underwent successful ISR PCI. ISR PCI was independently associated with a higher 2-year risk of TVF (adjusted hazard ratio [HR] 1.95; 95% CI 1.68-2.27; P <.001) and stent thrombosis (adjusted HR 1.95; 95% CI 1.08-3.51; P =.027) but not bleeding (adjusted HR 0.94; 95% CI 0.73-1.21; P =.64). There was no statistical interaction between HPR and ISR versus non-ISR PCI in regard to TVF (adjusted Pinteraction =.81). Conclusions: ISR PCI is associated with a considerably higher risk of 2-year adverse ischemic events, with HPR conferring similar risk in ISR and non-ISR PCI. More effective therapeutic strategies for managing ISR lesions are necessary.

Original languageEnglish (US)
Pages (from-to)142-149
Number of pages8
JournalAmerican Heart Journal
Volume197
DOIs
StatePublished - Mar 1 2018
Externally publishedYes

Fingerprint

Drug-Eluting Stents
Percutaneous Coronary Intervention
Stents
Blood Platelets
clopidogrel
Proportional Hazards Models
Myocardial Ischemia
Cause of Death

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Redfors, Björn ; Genereux, Philippe ; Witzenbichler, Bernhard ; Maehara, Akiko ; Weisz, Giora ; McAndrew, Thomas ; Mehran, Roxana ; Kirtane, Ajay J. ; Stone, Gregg W. / Percutaneous coronary intervention of lesions with in-stent restenosis : A report from the ADAPT-DES study. In: American Heart Journal. 2018 ; Vol. 197. pp. 142-149.
@article{8ac4300672f6498699b5c8ab5efc3efe,
title = "Percutaneous coronary intervention of lesions with in-stent restenosis: A report from the ADAPT-DES study",
abstract = "Background: There is a paucity of data from large contemporary cohorts of patients with in-stent restenosis (ISR) treated with drug-eluting stents (DESs), and no studies have examined the impact of high platelet reactivity (HPR) on the occurrence of ischemic events after ISR percutaneous coronary intervention (PCI) with DESs. We sought to report outcomes after PCI of ISR lesions and its association with HPR. Methods: Patients in the prospective, multicenter ADAPT-DES study were stratified according to whether they had ISR versus non-ISR PCI. Two-year outcomes were compared between the groups using Cox proportional hazards models. HPR was defined as on-clopidogrel P2Y12 platelet reaction units >208 as measured by the VerifyNow assay; target vessel failure (TVF) was defined as the composite of all-cause death, myocardial infarction, or ischemia-driven target vessel revascularization. Results: Among the 8,582 patients included in the ADAPT-DES study, 840 (9.8{\%}) patients underwent successful ISR PCI. ISR PCI was independently associated with a higher 2-year risk of TVF (adjusted hazard ratio [HR] 1.95; 95{\%} CI 1.68-2.27; P <.001) and stent thrombosis (adjusted HR 1.95; 95{\%} CI 1.08-3.51; P =.027) but not bleeding (adjusted HR 0.94; 95{\%} CI 0.73-1.21; P =.64). There was no statistical interaction between HPR and ISR versus non-ISR PCI in regard to TVF (adjusted Pinteraction =.81). Conclusions: ISR PCI is associated with a considerably higher risk of 2-year adverse ischemic events, with HPR conferring similar risk in ISR and non-ISR PCI. More effective therapeutic strategies for managing ISR lesions are necessary.",
author = "Bj{\"o}rn Redfors and Philippe Genereux and Bernhard Witzenbichler and Akiko Maehara and Giora Weisz and Thomas McAndrew and Roxana Mehran and Kirtane, {Ajay J.} and Stone, {Gregg W.}",
year = "2018",
month = "3",
day = "1",
doi = "10.1016/j.ahj.2017.11.011",
language = "English (US)",
volume = "197",
pages = "142--149",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",

}

Redfors, B, Genereux, P, Witzenbichler, B, Maehara, A, Weisz, G, McAndrew, T, Mehran, R, Kirtane, AJ & Stone, GW 2018, 'Percutaneous coronary intervention of lesions with in-stent restenosis: A report from the ADAPT-DES study', American Heart Journal, vol. 197, pp. 142-149. https://doi.org/10.1016/j.ahj.2017.11.011

Percutaneous coronary intervention of lesions with in-stent restenosis : A report from the ADAPT-DES study. / Redfors, Björn; Genereux, Philippe; Witzenbichler, Bernhard; Maehara, Akiko; Weisz, Giora; McAndrew, Thomas; Mehran, Roxana; Kirtane, Ajay J.; Stone, Gregg W.

In: American Heart Journal, Vol. 197, 01.03.2018, p. 142-149.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Percutaneous coronary intervention of lesions with in-stent restenosis

T2 - A report from the ADAPT-DES study

AU - Redfors, Björn

AU - Genereux, Philippe

AU - Witzenbichler, Bernhard

AU - Maehara, Akiko

AU - Weisz, Giora

AU - McAndrew, Thomas

AU - Mehran, Roxana

AU - Kirtane, Ajay J.

AU - Stone, Gregg W.

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Background: There is a paucity of data from large contemporary cohorts of patients with in-stent restenosis (ISR) treated with drug-eluting stents (DESs), and no studies have examined the impact of high platelet reactivity (HPR) on the occurrence of ischemic events after ISR percutaneous coronary intervention (PCI) with DESs. We sought to report outcomes after PCI of ISR lesions and its association with HPR. Methods: Patients in the prospective, multicenter ADAPT-DES study were stratified according to whether they had ISR versus non-ISR PCI. Two-year outcomes were compared between the groups using Cox proportional hazards models. HPR was defined as on-clopidogrel P2Y12 platelet reaction units >208 as measured by the VerifyNow assay; target vessel failure (TVF) was defined as the composite of all-cause death, myocardial infarction, or ischemia-driven target vessel revascularization. Results: Among the 8,582 patients included in the ADAPT-DES study, 840 (9.8%) patients underwent successful ISR PCI. ISR PCI was independently associated with a higher 2-year risk of TVF (adjusted hazard ratio [HR] 1.95; 95% CI 1.68-2.27; P <.001) and stent thrombosis (adjusted HR 1.95; 95% CI 1.08-3.51; P =.027) but not bleeding (adjusted HR 0.94; 95% CI 0.73-1.21; P =.64). There was no statistical interaction between HPR and ISR versus non-ISR PCI in regard to TVF (adjusted Pinteraction =.81). Conclusions: ISR PCI is associated with a considerably higher risk of 2-year adverse ischemic events, with HPR conferring similar risk in ISR and non-ISR PCI. More effective therapeutic strategies for managing ISR lesions are necessary.

AB - Background: There is a paucity of data from large contemporary cohorts of patients with in-stent restenosis (ISR) treated with drug-eluting stents (DESs), and no studies have examined the impact of high platelet reactivity (HPR) on the occurrence of ischemic events after ISR percutaneous coronary intervention (PCI) with DESs. We sought to report outcomes after PCI of ISR lesions and its association with HPR. Methods: Patients in the prospective, multicenter ADAPT-DES study were stratified according to whether they had ISR versus non-ISR PCI. Two-year outcomes were compared between the groups using Cox proportional hazards models. HPR was defined as on-clopidogrel P2Y12 platelet reaction units >208 as measured by the VerifyNow assay; target vessel failure (TVF) was defined as the composite of all-cause death, myocardial infarction, or ischemia-driven target vessel revascularization. Results: Among the 8,582 patients included in the ADAPT-DES study, 840 (9.8%) patients underwent successful ISR PCI. ISR PCI was independently associated with a higher 2-year risk of TVF (adjusted hazard ratio [HR] 1.95; 95% CI 1.68-2.27; P <.001) and stent thrombosis (adjusted HR 1.95; 95% CI 1.08-3.51; P =.027) but not bleeding (adjusted HR 0.94; 95% CI 0.73-1.21; P =.64). There was no statistical interaction between HPR and ISR versus non-ISR PCI in regard to TVF (adjusted Pinteraction =.81). Conclusions: ISR PCI is associated with a considerably higher risk of 2-year adverse ischemic events, with HPR conferring similar risk in ISR and non-ISR PCI. More effective therapeutic strategies for managing ISR lesions are necessary.

UR - http://www.scopus.com/inward/record.url?scp=85041389105&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85041389105&partnerID=8YFLogxK

U2 - 10.1016/j.ahj.2017.11.011

DO - 10.1016/j.ahj.2017.11.011

M3 - Article

VL - 197

SP - 142

EP - 149

JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

ER -