Predictive factors of cardiac events after implantation of sirolimus-eluting stents for treatment of in-stent restenosis

The factors associated with recurrent restenosis after SES implantation for in-stent restenosis are unknown. This study aimed to assess the clinical outcome and to analyse predictive factors of cardiac events in patients with in-stent restenosis treated with Sirolimus-eluting stent (SES). In 3 centers, consecutive patients ( n = 100) with elective indication to percutaneous coronary intervention (PCI) for in-stent restenosis ( n = 110) were treated with SES: 28 lesions were focal, 40 diffuse, 17 proliferative, and 15 showed total occlusion. SES implantation was successful in all patients, without complication during the first hospital stay. The mean follow-up was 15 (10–24) months. A cardiac event related to the target vessel occurred in 24 (24%) patients, and was associated with dialysis status ( p < 0.05), lower ejection fraction ( p < 0.05) and revascularization without SES in another site ( p < 0.0001). A cardiac event related to the SES occurred in 11 (11%) patients, secondary to an acute or sub-acute thrombosis of the SES (2%), to a late occlusion of the target vessel (4%) or to a non-occlusive restenosis of the SES (5%), and was associated with unstable angina ( p < 0.01), multivessel disease ( p < 0.03) and revascularization without SES in another site ( p < 0.03). No cardiac event related to the SES occurred in patients with direct stenting. Target lesion revascularization for in-SES restenosis or occlusion of the target vessel was performed in 7 (7%) patients, and was associated with unstable angina ( p < 0.01) and revascularization without SES in another site ( p < 0.01). Target vessel revascularization was needed in 20 patients (20%), related to dialysis status ( p < 0.01) and a revascularization without SES in another site ( p < .0001). SESs are effective in the treatment of high risk patients with complex in-stent restenosis. Most of cardiac events during follow-up are related to a revascularization without SES in another site.