Eight-Year Incidence and Management of In-Stent Restenosis Evaluated in the VA CART Program
June 28, 2017—A study of the National Veterans Administration Cardiovascular Assessment, Reporting, and Tracking (VA CART) program evaluated the temporal trends in the incidence, procedural management, and clinical outcomes of coronary in-stent restenosis (ISR), as well as the association between different treatment modalities and clinical outcomes. Stephen W. Waldo MD, et al published the findings online ahead of print in Catheterization and Cardiovascular Interventions.
The investigators stated that they identified all patients treated for coronary ISR within the VA Healthcare System from October 1, 2006 to September 30, 2014. They assessed temporal trends in incidence as well as intraprocedural management. Among patients treated for single-vessel restenosis, a propensity-matched cohort was created for those treated with drug-eluting stents (DES) or other treatment modalities. Target vessel revascularization (TVR) and mortality were compared between the two subpopulations.
As summarized in Catheterization and Cardiovascular Interventions, there were 65,443 patients who underwent percutaneous coronary intervention from 2006 to 2014 registered in the VA CART program. Of these, 6,872 patients (10.5%) with 8,921 lesions were treated for ISR.
The investigators reported that the proportion of patients undergoing revascularization for restenosis increased 0.28% per year (P = .055). Among a propensity-matched cohort of 6,231, the rates of TVR (subdistribution hazard ratio [HR], 0.623; 95% confidence interval [CI], 0.511–0.76) and mortality (HR, 0.73; 95% CI, 0.641–0.83) were significantly lower among patients treated with a DES compared with other treatments. After adjustment for known risk factors, treatment with DES continued to be associated with a reduction in mortality rate (adjusted HR, 0.802; 95% CI, 0.704–0.913).
There is a trend toward an increasing proportion of coronary interventions for ISR in a national cohort of veterans and treatment with a DES is associated with the lowest rate of TVR and overall mortality, concluded the investigators in Catheterization and Cardiovascular Interventions.