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Clin. Cardiol. 24, 551–555 (2001)
Jae-Hwan Lee, M.D., Cheol Whan Lee, M.D., Seong-Wook Park, M.D., Ph.D., Myeong-Ki Hong, M.D., Ph.D., Jae-Joong Kim, M.D., Ph.D., Kyoung Suk Rhee, M.D., Seung-Jung Park, M.D., Ph.D.
Department of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
Summary
Background: Many patients with in-stent restenosis (ISR) are angina-free, but the optimal treatment for these patients remains uncertain.
Hypothesis: In cases with asymptomatic moderate noncritical ISR, deferral of the intervention may be safe and associated with favorable clinical outcome.
Methods: We evaluated the long-term clinical outcome of asymptomatic patients (Group 1, n = 98) with moderate noncritical ISR (<70% diameter stenosis) after intervention was deferred, and compared it with that of patients (Group 2, n = 655) without restenosis. After repeat angioplasty was deferred, all patients were treated medically and later underwent angioplasty only in the case of clinical recurrence.
Results: Baseline characteristics were similar between the two groups. Clinical follow-up was available in all patients at 26.3 ± 15.9 months. Twenty patients died during the follow-up: 1 in Group 1 and 19 in Group 2. Target lesion revasculariza-tion was performed in 3 patients in Group 1 and 11 patients in Group 2 during follow-up (p = NS), and new lesion revascularization in 2 patients in Group 1 and 27 patients in Group 2 (p = NS). Event-free survival rate (cardiac death, nonfatal myocardial infarction, repeat revascularization) was 86.7 ± 6.1% in Group 1 and 84.8 ± 2.2% in Group 2 at the end of follow-up (p = NS). Major adverse cardiac events were only associated with the presence of diabetic mellitus (hazards ratio 2.65, 95% confidence interval [CI] 1.48–4.73, p < 0.01). The percentage of patients receiving antianginal medication was similar between the two groups at the end of the study (p = NS).
Conclusions: Asymptomatic patients with moderate noncritical ISR have a good prognosis and similar clinical outcome as those without ISR, suggesting that it may be safe to defer repeat angioplasty in these patients until angina recurrence.
Key words: stent, restenosis, prognosis
This study was supported by a grant from the Asan Institute for Life Science (#97-060).
Address for reprints:
Seung-Jung Park, M.D., Ph.D.
Department of Medicine
Asan Medical Center
University of Ulsan
388-1 Pungnap-dong, Songpa-gu
Seoul, 138-736, Korea
Received: May 10, 2000
Accepted with revision: December 7, 2000