Résumé
Despite the evolution of stent technology, there is a non-negligible risk of in-stent restenosis (ISR) after Percutaneous coronary intervention (PCI). Large-scale registry data on the prevalence and clinical management of ISR is lacking.
The aim was to describe the epidemiology and management of patients with ≥1 ISR lesions treated with PCI (ISR PCI). Data on characteristics, management and clinical outcomes were analyzed for patients undergoing ISR PCI in the France-PCI all-comers registry.
Between January 2014 and December 2018, 31,892 lesions were treated in 22,592 patients, 7.3 % of whom underwent ISR PCI. Patients undergoing ISR PCI were older (68.5 vs 67.8; p < 0.001), and more likely to have diabetes (32.7 % vs 25.4 %, p < 0.001), chronic coronary syndrome or multivessel disease. ISR PCI concerned drug eluting stents (DES) ISR in 48.8 % of cases. Patients with ISR lesions were more frequently treated with DES than drug eluting balloon or balloon angioplasty (74.2 %, 11.6 % and 12.9 %, respectively). Intravascular imaging was rarely used. At 1 year, patients with ISR had higher target lesion revascularization rates (4.3 % vs. 1.6 %; HR 2.24 [1.64–3.06]; p < 0.001).
In a large all-comers registry, ISR PCI was not infrequent and associated with worse prognosis than non-ISR PCI. Further studies and technical improvements are warranted to improve the outcomes of ISR PCI.
Abbreviations: DEB: drug eluting balloon; DES: drug eluting stent; HR: hazard ratio; POBA: plain old balloon angioplasty; ISR: in-stent restenosis; TLR: target lesion revascularization. [Display omitted]
•ISR PCI is performed with relevant frequency in routine clinical practice (7-8%).•Approximately 10-20% of ISR are treated with POBA.•Intravascular imaging is largely underused (< 2%).•At 1 year, patients with ISR PCI have higher TLR rates than non-ISR PCI (4.3% vs. 1.6%; HR 2.24 [1.64-3.06]; p<0.001).