Incidence, procedural management, and clinical outcomes of coronary in-stent restenosis: Insights from the National VA CART Program.
Catheter Cardiovasc Interv
; 91(3): 425-433, 2018 02 15.
Article
em En
| MEDLINE
| ID: mdl-28657149
ABSTRACT
BACKROUND In-stent restenosis (ISR) remains a common clinical problem associated with significant morbidity. We sought to evaluate the temporal trends in incidence and procedural management of coronary restenosis as well as evaluate the association between different treatment modalities and clinical outcomes. METHODS:
We identified all patients treated for coronary ISR within the Veterans Affairs Healthcare System from October 1, 2006 to September 30, 2014. The temporal trends in incidence as well as intraprocedural management were assessed. Among patients treated for single vessel restenosis, a propensity matched cohort was created for those treated with drug-eluting stents (DES) or other treatment modalities. Target vessel revascularization (TVR) and mortality were compared between the two subpopulations.RESULTS:
From 2006 to 2014, 65,443 patients underwent percutaneous coronary intervention and 6,872 patients (10.5%) with 8,921 lesions were treated for ISR. The proportion of patients undergoing revascularization for restenosis increased 0.28% per year (P = 0.055). Among a propensity-matched cohort of 6,231, the rates of TVR (subdistribution HR 0.623, 95% CI 0.511-0.760) and mortality (HR 0.730, 95% CI 0.641-0.830) were significantly lower among patients treated with a DES compared with other treatments. After adjustment for known risk factors, treatment with DES continued to be associated with a reduction in mortality rate (Adjusted HR 0.802, 95% CI 0.704-0.913).CONCLUSIONS:
There is a trend toward an increasing proportion of coronary interventions for ISR in a national cohort of Veterans and treatment with a DES is associated with the lowest rate of TVR and overall mortality.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Angioplastia Coronária com Balão
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Stents
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United States Department of Veterans Affairs
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Reestenose Coronária
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Intervenção Coronária Percutânea
Tipo de estudo:
Etiology_studies
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
País como assunto:
America do norte
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article