Comparison of demographic and procedural characteristics of patients with elective percutaneous coronary interventions according to the presence of in-stent restenosis: biannual results from the University Hospital Merkur

    Authors

    Keywords

    in-stent restenosis, percutaneous coronary intervention, drug-eluting stent, drug-elutin ballon

    DOI

    https://doi.org/10.15836/ccar2016.121

    Full Text

    **Background**: In-stent restenosis (ISR) is an important clinical problem. Underlying cause of ISR can be variable and is believed to be different from the pathophysiology of atherosclerosis in the native vessels. (1) Such different mechanisms could, at least in part, be explained by different demographic characteristics of ISR and non-ISR patients. They could also lead to different approaches to percutaneous coronary interventions (PCI) in those two groups. **Patients and Methods**: We conducted this retrospective analysis, of our interventional data, in order to find such differences. In years 2014 and 2015 there were 657 elective PCI procedures (41 ISR and 616 non ISR interventions) in our institution. **Results**: We found no significant differences in major demographic characteristics in ISR vs. non-ISR patients (**Table 1**). Analysis of procedural characteristics (**Table 2**) showed that we were probably more aggressive with predilatation in ISR (number of balloons used 1.53±0.59 vs. 1.34±0.77; p=0.03). We were less keen to implant a stent in ISR patients (21.9% vs. 82.3%; p<0.001) but when implanted one it was more frequently a drug eluting stent (100% vs. 36.9%; p<0.001). We used more drug eluting balloons for ISR (65.8% vs. 3.7%; p<0.001). No other significant differences in procedural characteristics examined were found. ### Table 1: Demographic characteristics of patients according to the presence of in-stent restenosis. | **Characteristic** | **ISR (n=41)** | **Non ISR (n=616)** | **p-value** | | --- | --- | --- | --- | | **Age (mean±SD)** | 65.9±7.9 | 64.3±9.7 | 0.38 | | **Male sex (n/%)** | 31/77.5 | 434/70.4 | 0.48 | | **Hypertension (n/%)** | 40/97.5 | 587/95.3 | 0.52 | | **Hyperlipidaemia (n/%)** | 41/100 | 566/91.8 | 0.06 | | **Smoking (n/%)** | 9/21.9 | 177/28.7 | 0.56 | | **Diabetes (n/%)** | 11/26.8 | 208/33.7 | 0.92 | | **Previous MI (n/%)** | 22/53.6 | 284/46.1 | 0.89 | | **Previous PCI (n/%)** | 41/100 | 193/31.3 | <0.001* | | **Previous CABG (n/%)** | 1/2.4 | 19/3.0 | 0.25 | [†] ISR = in-stent restenosis; MI = myocardial infarction; PCI = percutaneous coronary intervention; CABG = coronary artery bypass graft; n = number; SD = standard deviation. Mann Whitney test was used for continuous and chi-square for nominal variables. *p<0.05 ### Table 2: Procedural characetristic. | **Characteristic** | **ISR (n=41)** | **Non ISR (n=616)** | **p-value** | | --- | --- | --- | --- | | **LAD//Cx//RCA//Graft//LMCA (n)** | 15//5//19//1//1 | 187/161/258/1/9 | 0.47 | | **Predilatation (n/%)** | 41/100 | 557/90.4 | 0.14 | | **Number of balloons – predilatation (mean±SD)** | 1.53±0.59 | 1.34±0.77 | 0.03* | | **Stent implantation (n/%)** | 9/21.9 | 507/82.3 | <0.001* | | **Number of implanted stents (mean± SD)** | 1.0±0.31 | 1.12±0.51 | 0.31 | | **DES penetration (n/%)** | 9/100 | 219/36.9 | <0,001* | | **DEB application (n/%)** | 27/65.8 | 23/3.7 | <0.001* | | **Postdilatation (n/%)** | 1/2.4 | 62/10.0 | 0.10 | | **Fluoro time in min (mean±SD)** | 8.04±4.51 | 10.09±9.24 | 0.69 | | **Contrast in ml (mean±SD)** | 159.41±67.26 | 165.15±77.49 | 0.76 | [†] ISR = in-stent restenosis; LAD = left anterior descending; Cx = circumflex; RCA = right coronary artery; LMCA = left-main coronary artery; DES = drug-eluting stent; DEB = drug-eluting balloon; n = number; SD = standard deviation. Mann Whitney test was used for continuous and chi-square for nominal variables. *p<0.05 **Conclusion**: There were no significant demographic differences in ISR vs. non-ISR patients treated in our institution. Procedural differences that were found reflect, at least in some part, well known recommendations for ISR interventions. On the other hand, they also probably reflect specific organizational and financial issues of our catheterization laboratory.

    Literature

    1. Alfonso F, Byrne RA, Rivero F, Kastrati A. Current treatment of in-stent restenosis. J Am Coll Cardiol. 2014;63(24):2659–73. https://doi.org/10.1016/j.jacc.2014.02.545
    Cardiologia Croatica
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    Comparison of demographic and procedural characteristics of patients with elective percutaneous coronary interventions according to the presence of in-stent restenosis: biannual results from the University Hospital Merkur

    Abstract
    Issue3-4
    Published
    Pages121-122
    PDF via DOIhttps://doi.org/10.15836/ccar2016.121
    in-stent restenosis
    percutaneous coronary intervention
    drug-eluting stent
    drug-elutin ballon

    Authors

    Tomislav Letilović*ORCIDUniversity Hospital Merkur, Zagreb, Croatia
    Damir KozmarORCIDUniversity Hospital Merkur, Zagreb, Croatia
    Stjepan KranjčevićORCIDUniversity Hospital Merkur, Zagreb, Croatia
    Darko PočanićUniversity Hospital Merkur, Zagreb, Croatia
    Helena JerkićORCIDUniversity Hospital Merkur, Zagreb, Croatia
    Maro DragičevićORCIDUniversity Hospital Merkur, Zagreb, Croatia
    Mario StipinovićORCIDUniversity Hospital Merkur, Zagreb, Croatia
    Ena KurtićORCIDUniversity Hospital Merkur, Zagreb, Croatia

    *Correspondence email: letilovic@yahoo.com

    Full Text

    Background: In-stent restenosis (ISR) is an important clinical problem. Underlying cause of ISR can be variable and is believed to be different from the pathophysiology of atherosclerosis in the native vessels. (1) Such different mechanisms could, at least in part, be explained by different demographic characteristics of ISR and non-ISR patients. They could also lead to different approaches to percutaneous coronary interventions (PCI) in those two groups.

    Patients and Methods: We conducted this retrospective analysis, of our interventional data, in order to find such differences. In years 2014 and 2015 there were 657 elective PCI procedures (41 ISR and 616 non ISR interventions) in our institution.

    Results: We found no significant differences in major demographic characteristics in ISR vs. non-ISR patients (Table 1). Analysis of procedural characteristics (Table 2) showed that we were probably more aggressive with predilatation in ISR (number of balloons used 1.53±0.59 vs. 1.34±0.77; p=0.03). We were less keen to implant a stent in ISR patients (21.9% vs. 82.3%; p<0.001) but when implanted one it was more frequently a drug eluting stent (100% vs. 36.9%; p<0.001). We used more drug eluting balloons for ISR (65.8% vs. 3.7%; p<0.001). No other significant differences in procedural characteristics examined were found.

    Table 1: Demographic characteristics of patients according to the presence of in-stent restenosis.

    Age (mean±SD)
    ISR (n=41)
    65.9±7.9
    Non ISR (n=616)
    64.3±9.7
    p-value
    0.38
    Male sex (n/%)
    ISR (n=41)
    31/77.5
    Non ISR (n=616)
    434/70.4
    p-value
    0.48
    Hypertension (n/%)
    ISR (n=41)
    40/97.5
    Non ISR (n=616)
    587/95.3
    p-value
    0.52
    Hyperlipidaemia (n/%)
    ISR (n=41)
    41/100
    Non ISR (n=616)
    566/91.8
    p-value
    0.06
    Smoking (n/%)
    ISR (n=41)
    9/21.9
    Non ISR (n=616)
    177/28.7
    p-value
    0.56
    Diabetes (n/%)
    ISR (n=41)
    11/26.8
    Non ISR (n=616)
    208/33.7
    p-value
    0.92
    Previous MI (n/%)
    ISR (n=41)
    22/53.6
    Non ISR (n=616)
    284/46.1
    p-value
    0.89
    Previous PCI (n/%)
    ISR (n=41)
    41/100
    Non ISR (n=616)
    193/31.3
    p-value
    <0.001*
    Previous CABG (n/%)
    ISR (n=41)
    1/2.4
    Non ISR (n=616)
    19/3.0
    p-value
    0.25

    ISR = in-stent restenosis; MI = myocardial infarction; PCI = percutaneous coronary intervention; CABG = coronary artery bypass graft; n = number; SD = standard deviation. Mann Whitney test was used for continuous and chi-square for nominal variables. *p<0.05

    Table 2: Procedural characetristic.

    LAD//Cx//RCA//Graft//LMCA (n)
    ISR (n=41)
    15//5//19//1//1
    Non ISR (n=616)
    187/161/258/1/9
    p-value
    0.47
    Predilatation (n/%)
    ISR (n=41)
    41/100
    Non ISR (n=616)
    557/90.4
    p-value
    0.14
    Number of balloons – predilatation (mean±SD)
    ISR (n=41)
    1.53±0.59
    Non ISR (n=616)
    1.34±0.77
    p-value
    0.03*
    Stent implantation (n/%)
    ISR (n=41)
    9/21.9
    Non ISR (n=616)
    507/82.3
    p-value
    <0.001*
    Number of implanted stents (mean± SD)
    ISR (n=41)
    1.0±0.31
    Non ISR (n=616)
    1.12±0.51
    p-value
    0.31
    DES penetration (n/%)
    ISR (n=41)
    9/100
    Non ISR (n=616)
    219/36.9
    p-value
    <0,001*
    DEB application (n/%)
    ISR (n=41)
    27/65.8
    Non ISR (n=616)
    23/3.7
    p-value
    <0.001*
    Postdilatation (n/%)
    ISR (n=41)
    1/2.4
    Non ISR (n=616)
    62/10.0
    p-value
    0.10
    Fluoro time in min (mean±SD)
    ISR (n=41)
    8.04±4.51
    Non ISR (n=616)
    10.09±9.24
    p-value
    0.69
    Contrast in ml (mean±SD)
    ISR (n=41)
    159.41±67.26
    Non ISR (n=616)
    165.15±77.49
    p-value
    0.76

    ISR = in-stent restenosis; LAD = left anterior descending; Cx = circumflex; RCA = right coronary artery; LMCA = left-main coronary artery; DES = drug-eluting stent; DEB = drug-eluting balloon; n = number; SD = standard deviation. Mann Whitney test was used for continuous and chi-square for nominal variables. *p<0.05

    Conclusion: There were no significant demographic differences in ISR vs. non-ISR patients treated in our institution. Procedural differences that were found reflect, at least in some part, well known recommendations for ISR interventions. On the other hand, they also probably reflect specific organizational and financial issues of our catheterization laboratory.

    Literature

    1. 1.
      Alfonso F, Byrne RA, Rivero F, Kastrati A. Current treatment of in-stent restenosis. J Am Coll Cardiol. 2014;63(24):2659–73.DOI