The Impact of In-stent Restenosis Detected upon Routine Follow-up Angiography after Percutaneous Coronary Intervention with Metallic Stent

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Aims: The prognostic impact of in-stent restenosis (ISR) detected upon routine follow-up coronary angiography (RFU-CAG) after percutaneous coronary intervention (PCI) has been unclear. The aim of our study was to compare the clinical outcomes after RFU-CAG between patients with and without ISR detected upon RFU-CAG.
Methods and results: A total of 824 patients who underwent PCI and RFU-CAG were analysed. Patients were divided into two groups: those with ISR (n=112) and those without (n=712). Outcomes were compared between patients with ISR and those without detected upon RFU-CAG. The study patients were followed up for a median of 1,323 (709 to 2,130) days. The incidence of a major adverse cardiac event (MACE), defined as all-cause death, any myocardial infarction, stroke, revascularisation for de novo lesion(s) or hospitalisation for heart failure was significantly higher in patients with ISR than in those without (45.5% vs. 24.4%, respectively; p<0.01). Specifically, patients with ISR had a higher incidence of all-cause death (16.1% vs. 6.2%, respectively; p<0.01) and revascularisation for de novo lesion(s) (28.6% vs. 16.2%, respectively; p<0.01). Even after adjustment for possible confounders, ISR detected upon RFU-CAG was an independent predictor for MACE (Hazard ratio: 2.13; 95% confidence interval: 1.55 to 2.92: p<0.01)
Conclusions: ISR detected upon RFU-CAG were independently associated with an increased MACE, which was mainly driven by an increased incidence of all-cause death and revascularisation for de novo lesion(s).