Contemporary treatment of in-stent restenosis and the incidence of recurrent in-stent restenosis in the era of drug-eluting stents.

BACKGROUND: Optimal treatment of in-stent restenosis (ISR) remains uncertain in the era of drug-eluting stents (DES). This study aims to determine contemporary treatment of ISR and to assess recurrent ISR rates in the era of DES. METHODS: We examined 60 patients presenting for treatment of ISR (one lesion per patient) who were enrolled in the Melbourne Interventional Group Registry (4% of total population of 1423 patients) between April 2004 and January 2005. Twelve-month follow-up is complete for all patients. RESULTS: The majority of ISR treated occurred in bare metal stents [BMS (n=52, 87%)] and had a focal (<10 mm) pattern of ISR (53%). In-stent restenosis of DES occurred in eight (13%) patients. The majority of ISR were treated with additional stenting with a preference for DES over BMS in almost all cases. At 12 months, one patient died of non-cardiac cause and four patients (7%) presented with recurrent ISR. The incidence of recurrent ISR in DES was 5% (n=3). No late thrombosis was reported despite only 50% of patients having >or=12 months of clopidogrel therapy. CONCLUSIONS: Our study suggests drug-eluting stents are safe, effective and the preferred therapy for in-stent restenosis. The incidence of recurrent drug-eluting stent restenosis at 12 months is low.

Does the presence of heart failure alter prescribing of drug therapy after myocardial infarction? A multicentre study.

OBJECTIVE: To evaluate the use of cardiovascular medications in patients with and without heart failure after myocardial infarction (MI). DESIGN AND SETTING: Multicentre study of drug therapy for patients with MI in 16 major metropolitan teaching hospitals in Australia over a 1-month period at each hospital in the period November 2004 - March 2005. PARTICIPANTS: 479 patients admitted consecutively to the individual hospitals. MAIN OUTCOME MEASURES: Proportion of patients with and without heart failure who were prescribed key cardiovascular medications after MI. RESULTS: 116 of the 479 patients admitted for MI (24.2%) had heart failure at some point during their hospitalisation. Patients with heart failure were older (68 v 63 years; P < 0.05), more likely to be women (34% v 24%; P < 0.05) and a higher proportion had diabetes (26% v 21%). There was significantly reduced prescribing of beta-blockers, clopidogrel and statins for patients with heart failure compared with those without heart failure. Mineralocorticoid receptor antagonist use was low (< 10%) in the former group. CONCLUSIONS: We found reduced prescribing of some prognostically relevant medications for patients with heart failure. For beta-blockers, this may be explained by the greater clinical instability in patients with heart failure. Given the absolute benefit of drug therapy in patients with heart failure after MI, our findings suggest suboptimal prescribing in Australian teaching hospital practice.