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ȣ - 510325 41 |
| Are there differences in clinical outcomes after target-lesion revascularization for restenosis according to the types of restenosed drug-eluting stents? Comparisons between sirolimus-eluting versus paclitaxel-eluting stent restenosis |
| 국민건강보험공단 일산병원 심장혈관센터 순환기 내과¹, 연세대학교 의과대학 신촌 세브란스 심장혈관병원²,영동 세브란스 심장혈관병원³, 연세대 의대 원주 기독 병원⁴,이화여대 목동 병원5, 한림대 의대 강남 성심 병원6, 인제대 의대 상계 백병 |
| 김병극¹, 오성진¹, 전동운¹, 김중선², 최동훈², 장양수², 홍범기³, 권혁문³, 이승환⁴, 권기환5, 정재헌6, 고충원7, 양주영¹ |
Background and Objectives: Currently, it is unknown whether the types of restenosed drug-eluting stent (DES) could affect the outcomes of target-lesion revascularization (TLR) for DES-restenosis. The aim of this study is to evaluate clinical outcomes of TLR in patients with restenosis after DES implantation and to compare the incidences of recurrent cardiac events after TLR for sirolimus-eluting stent (SES) restenosis with those after TLR for paclitaxel-eluting stent (PES) restenosis in the Korean Multicenter Angioplasty Team (KOMATE) registry. Subjects and Methods: Between March 2003 and March 2006, a total of 98 patients with 112 lesions have undergone TLR to treat DES restenosis. We divided these patients into 2 groups based on the types of restenosed DES (SES-restenosis group; 49 patients with 53 lesions, PES-restenosis group; 49 patients with 59 lesions) Results: There were no differences in the baseline clinical and angiographic characteristics between the 2 groups, except for de-novo lesion length (SES- vs. PES-restenosis; 29.2±12.9 vs. 22.5±12.1 mm, p=0.006). A focal pattern of restenosis was observed in 46 (87%) lesions of SES-restenosis group and 34 (58%) lesions in PES restenosis group, respectively (p=0.001). The types of TLR for restenosis were similar between both groups [SES- vs. PES-restenosis; balloon or cutting balloon angioplasty, 43(81%) vs. 44(75%) lesions, repeated DES implantation; 10(19%) vs. 15(25%) lesions, p=0.497]. Over a mean follow-up of 23.4±9.9 months, there was no incidence of cardiac death, myocardial infarction, and definite or probable stent thrombosis by Academic Research Consortium definition. The overall incidences of major adverse cardiac events (MACE) were similar between the 2 groups (SES- vs. PES-restenosis; 26% vs. 12%, p=0.124). Using Kaplan-Meier methods, the cumulative MACE-free rates at 2 years were found to be 63% in SES- and 84% in PES-restenosis group, respectively (Log Rank test, p=0.048). Conclusions: The TLR for DES-restenosis showed acceptable and favorable clinical outcomes. In addition, this study suggests that the TLR in patients with PES-restenosis might be associated with a lower rate of MACE than that of SES-restenosis.
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