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Repeat revascularization required in more than 10% of cases after PCI
Repeat revascularization after PCI was needed about 12% of the time in the drug-eluting stent era, with about one-fourth being staged or planned within the first 2 months, and half of all unplanned procedures being performed for target lesion revascularization.
In the study, researchers derived outcomes in the current era of DES by applying data from the multicenter EVENT registry to evaluate staged revascularization, TLR and other nontarget revascularizations 1 year after PCI.
Researchers enrolled more than 10,000 patients undergoing PCI from July 2004 to June 2007 at 55 hospitals, of whom 86% were treated with at least one DES. Within 1 year, 12% underwent repeat revascularization (3% staged; 9% unplanned), and more than 75% of staged revascularizations were done less than 30 days after the first PCI.
TLR was needed in 4.5% of patients, with higher hazard rates from 2 to 9 months after PCI, whereas the risk for unplanned non-TLR (4.4% cumulative incidence) was constant over time.
Researchers said future efforts should concentrate as much on identifying ischemia-producing lesions and intensifying secondary prevention therapies as on the prevention of restenosis.
“Our findings suggest that only modest improvements in reducing short-term atherosclerotic progression have been achieved, at least in terms of the impact on subsequent revascularization of nontarget coronary lesions,” researchers wrote. “Part of this persistent need for nontarget revascularization may stem from wire trauma or adverse effects from first-generation DES on the downstream vessel, thus increasing rates of TVR, and some events may occur as a result of unrecognized ischemia-producing stenoses in both the target vessel and in nontarget vessels.”
Disclosure: Funding for the EVENT registry was provided by grants from Millennium Pharmaceuticals and Merck Schering Plough Inc. See the study for a full list of financial disclosures.