The impact of multiple stent layers on the 10-year outcomes of patients treated with percutaneous coronary intervention for in-stent restenosis

Abstract

Patients undergoing percutaneous coronary intervention (PCI) for in-stent restenosis (ISR) with multiple stent layers represent a complex subgroup. However, the prognostic impact of multiple stent layers on long-term procedural and clinical outcomes remains unclear. To evaluate the association of multilayer versus single-layer lesions with long-term clinical outcomes and recurrent TLR in patients undergoing PCI for ISR. This post hoc analysis of a randomised trial included 402 patients who underwent PCI in 500 ISR lesions. Lesions were classified into two groups according to the number of stent layers present at baseline: multilayer (≥2 layers) vs. single-layer (1 layer). Ten-year clinical outcomes included cardiac death, myocardial infarction (MI), and target lesion revascularisation (TLR). Recurrent TLR during follow-up was assessed by counting first and all subsequent TLR procedures. Overall 112 lesions (80 patients) were classified as multilayer and 388 lesions (322 patients) as single-layer. At 10 years, rates of cardiac death (32.0% vs. 29.6%; HR=1.14; 95% CI 0.73–1.78; p = 0.55) and MI (10.1% vs. 5.4%; HR=1.98; 95% CI 0.85–4.63; p = 0.11) were not different in patients with multilayer versus single-layer ISR, rates of TLR were significantly higher in the multilayer group as compared to single-layer ISR (54.1% vs. 40.5%; HR=1.45; 95% CI 1.05–2.02; p = 0.03). Overall, ≥1 repeat PCI was performed in 204 of 500 lesions (40.8%). Compared with single-layer lesions, multilayer lesions were associated with a higher risk of both first TLR (54.1% vs. 39.0%; hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.10–2.13; p = 0.01) and total number of recurrent TLR (HR 1.41, 95% CI 1.03–1.93; p = 0.033). In patients undergoing PCI for ISR, lesions with 2 or more stent layers were associated with a higher risk of recurrent revascularisation than single-layer lesions. However, patients in the multilayer group did not have a higher risk of cardiac death or myocardial infarction.FigureFor image description, please refer to the figure legend and surrounding text.