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European Heart Journal 2000 21(9):754-762; doi:10.1053/euhj.1999.1906
Copyright © 2000 by the European Society of Cardiology.
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Predictors of event-free survival after repeat intracoronary procedure for in-stent restenosis. Study with angiographic and intravascular ultrasound imaging

F Schielef1, N Meneveau, M.-F Seronde, M.-F Deforet, S Gupta and J.-P Bassand

University Hospital Jean-Minjoz, Besançon, France

revised August 17, 1999; accepted August 18, 1999

Abstract

Aims Lumen enlargement during repeat percutaneous coronary intervention for in-stent restenosis has been shown to be the result of both stent over-expansion and decrease in neointimal tissue. How these two different mechanisms of action may influence outcome and target lesion revascularization after repeat intervention for in-stent restenosis is unclear.

Methods Intravascular ultrasound guided repeat intervention for in-stent restenosis was carried out either with balloon angioplasty, or with a combination of rotational atherectomy plus balloon angioplasty. Clinical follow-up at 1 year, including death, myocardial infarction, or need for revascularization, was obtained.

Results Seventy patients were included in this study; 40 were treated by balloon alone, and 30 by combination of rotational atherectomy plus balloon. Event-free survival probability was 76±5%. The mechanism of lumen enlargement, be it stent over-expansion or tissue removal, had no influence on long-term clinical evolution. The only independent predictor was the minimal lumen cross-sectional area at the end of the procedure, the larger the lumen cross-sectional area, the higher the event-free probability. The cut-off point of the lumen cross-sectional area was set at 4·7mm2by discriminant analysis. Event-free survival was 69±15% in patients with <4·7mm2lumen cross-sectional area and 91±8% in patients with >4·7mm2lumen cross-sectional area (P=0·008).

Conclusions This study showed that the only independent predictor of late clinical outcome after percutaneous re-intervention for in-stent restenosis was final lumen size, no matter which means were used to achieve it.

Key Words: In-stent restenosis, intravascular ultrasound, angioplasty, rotational atherectomy

f1 Correspondence: François Schiele, MD, FESC, Service de Cardiologie, Pôle Coeur-Poumons, Hôpital Universitaire Jean-Minjoz, Boulevard Fleming, 25030 Besançon Cedex, France

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