Original title: Clinical Presentation and Outcomes of Coronary In-Stent Restenosis Across 3-Stent Generations. Reference: Marco A. Magalhaes et al. Circ Cardiovasc Interv. 2014;7:00-00.
Studies evaluating the clinical presentation of restenosis after implantation of bare metal stent showed that the recurrence of stenosis is not a benign complication as previously thought, with a significant number of patients with restenosis as a clinic manifestation of acute coronary syndromes.
The study published by Magalhães et al in Circ. Cardiovascular Interventions aimed to evaluate the differences in the clinical presentation of stent restenosis when used 3 different generations of coronary stents: conventional (CONV), pharmacological (SF) first generation (Cypher and Taxus) and second generation (XIENCE V, Promus Element, Endeavor). Furthermore, the authors sought to determine whether the type of clinical presentation of restenosis (stable angina, silent ischemia, unstable angina, and acute myocardial infarction) was able to predict the occurrence of cardiac events (death, myocardial infarction, and revascularization) at six months follow-up. In this analysis 909 patients with 1077 lesions with restenosis and underwent a new percutaneous intervention were included.
The three groups of patients (n=388 CONV, SF first generation n=425 and SF second generation n=96), were relatively homogeneous in terms of basic clinical characteristics, despite the greater number of insulin-dependent diabetics in the latter group (32% versus 20% in the SF first generation group and 14% in the CONV group, p <0.001). Notwithstanding this, the type of clinical presentation of restenosis was similar in the three groups; the most common clinical manifestation was acute coronary syndrome (unstable angina or AMI) in about 2/3 of cases. Other important information from the study is that patients with stent restenosis and clinical manifestation of acute myocardial infarction were twice as likely to death, reinfarction, and target lesion revascularization at six months compared with those with unstable angina and four times, to those patients with stable angina. In addition, reinforcing the above data, patients in the original proceeding with implant of second generation drug-eluting stents had a 50% lower incidence of myocardial infarction compared with those who received conventional drug eluting stent or first generation.
Courtesy of Gilberto L. Nunes and Márcio Mossmann MDs (Brazil)
Dres Gilberto L. Nunes e Márcio Mossmann