RESEARCH HIGHLIGHTS Nature Reviews Cardiology 11, 688 (2014); published online 28 October 2014; doi:10.1038/nrcardio.2014.172


Restenosis predictive of 4-year mortality after stenting Restenosis of a stented lesion detected by routine follow-up angiography can be used to predict mortality, according to the investigators of a new study published in the European Heart Journal. While the introduction of drug-eluting stents has improved outcomes for patients, including reducing the likelihood of restenosis, this complication is still a major reason for the failure of percutaneous revascularization. “Restenosis detected by angiography is ... often considered a ‘benign’ complication without a significant impact on prognosis,” says Adnan Kastrati who led the team based in Munich, Germany. “The prognostic role of restenosis ... has not been investigated by sufficiently large cohort studies in patients treated with coronary stents,” adds Kastrati. The investigators enrolled 10,004 patients who had received a coronary stent between January 1998 and December 2009, and who underwent routine control angiography at 6–8 months. The primary outcome in this study was death at 4-year follow-up. Overall, restenosis was detected

in 2,643 individuals (26.4%). During follow-up, 702 patients died, 218 of whom had restenosis, whereas the remaining 484 had no evidence of restenosis on angiography (unadjusted HR 1.19, 95% CI 1.02–1.40, P = 0.03). After adjusting for variables using a Cox proportional hazard model, restenosis was still an independent predictor of 4-year mortality (HR 1.23, 95% CI 1.03–1.46, P = 0.02). “Restenosis detected by routine follow-up angiography is not as benign as it was thought before. Its occurrence predicts an increased risk of death at 4 years,” explains Kastrati. Other predictors of mortality included age, diabetes mellitus, tobacco smoking, and decreased left ventricular ejection fraction. Moreover, the association between restenosis and 4-year mortality was also true for patients who were asymptomatic (HR 1.40, 95% CI 1.05–1.77, P = 0.01). “Even in patients who do not present anginal symptoms at the time of follow-up angiography, restenosis still represents a significant risk factor of long-term mortality,” concludes



Kastrati, who predicts that “future studies may assess whether angiographic and intravascular information might guide optimal treatment strategies with the aim of improving prognosis of patients with restenosis after coronary stenting procedures”. Tim Geach Original article Cassese, S. et al. Prognostic role of restenosis in 10004 patients undergoing routine control angiography after coronary stenting. Eur. Heart J. doi:10.1093/eurheartj/ehu383

VOLUME 11  |  DECEMBER 2014 © 2014 Macmillan Publishers Limited. All rights reserved

Interventional cardiology: Restenosis predictive of 4-year mortality after stenting.

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