Long‐term follow‐up after deferring angioplasty in asymptomatic patients with moderate noncritical in‐stent restenosis

摘要

Background: Many patients with in‐stent restenosis (ISR) are angina‐free, but the optimal treatment for these patients remains uncertain. Hypothesis: In cases with asymptomatic moderate noncritical ISR, deferral of the intervention may be safe and associated with favorable clinical outcome. Methods: We evaluated the long‐term clinical outcome of asymptomatic patients (Group 1, n = 98) with moderate non‐critical ISR (< 70% diameter stenosis) after intervention was deferred, and compared it with that of patients (Group 2, n = 655) without restenosis. After repeat angioplasty was deferred, all patients were treated medically and later underwent angioplasty only in the case of clinical recurrence. Results: Baseline characteristics were similar between the two groups. Clinical follow‐up was available in all patients at 26.3 ± 15.9 months. Twenty patients died during the follow‐up: 1 in Group 1 and 19 in Group 2. Target lesion revascularization was performed in 3 patients in Group 1 and 11 patients in Group 2 during follow‐up (p = NS), and new lesion revascularization in 2 patients in Group 1 and 27 patients in Group 2 (p = NS). Event‐free survival rate (cardiac death, nonfatal myocardial infarction, repeat revascularization) was 86.7 ± 6.1% in Group 1 and 84.8 ± 2.2% in Group 2 at the end of follow‐up (p = NS). Major adverse cardiac events were only associated with the presence of diabetic mellitus (hazards ratio 2.65,95% confidence interval [CI] 1.48–4.73, p < 0.01). The percentage of patients receiving antianginal medication was similar between the two groups at the end of the study (p = NS). Conclusions: Asymptomatic patients with moderate non‐critical ISR have a good prognosis and similar clinical outcome as those without ISR, suggesting that it may be safe to defer repeat angioplasty in these patients until angina recurrence.