Very long-term (15 to 20 Years) clinical and angiographic outcome after coronary bare metal stent implantation

Kyohei Yamaji, Takeshi Kimura, Takeshi Morimoto, Yoshihisa Nakagawa, Katsumi Inoue, Yoshimitsu Soga, Takeshi Arita, Shinichi Shirai, Kenji Ando, Katsuhiro Kondo, Koyu Sakai, Masahiko Goya, Masashi Iwabuchi, Hiroyoshi Yokoi, Hideyuki Nosaka, Masakiyo Nobuyoshi

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Abstract

Background-We previously reported that the long-term luminal response after coronary bare metal stenting is triphasic, with an early restenosis phase spanning the 6 months after the index procedure, an intermediate-term regression phase from 6 months to 3 years, and a late renarrowing phase beyond 4 years. However, the clinical significance of late luminal renarrowing remains unknown. Methods and Results-Angiographic and clinical follow-up of the same cohort of 405 patients with successful Palmaz-Schatz stent placement was extended beyond 15 years. Clinical follow-up was completed in 98% of patients at 5 years and in 81% at 15 years. The incidence of death and cardiac death at 15 years was 45.4% and 20.6%, respectively. Paired long-term (4 to 10 years) and very long-term (>10 years) angiographic studies without intercurrent target lesion revascularization were performed in 55 lesions, and minimal luminal diameter further decreased from 1.88±0.50 mm to 1.60±0.73 mm (P=0.002). Late target lesion revascularization after initial stabilization of the stented segments occurred rarely within 4 years. Beyond 4 years, however, the incidence of late target lesion revascularization increased steadily from 3.3% at 4 years to 24.7% at 15 years. The incidence of definite very late stent thrombosis was low (1.5% at 15 years). Conclusions-Luminal renarrowing of the stented segment beyond 4 years was a progressive process extending beyond 10 years. The angiographic observation of late in-stent restenosis was clinically relevant because a corresponding progressive increase in the incidence of late target lesion revascularization was observed beyond 4 years and up to 15 to 20 years after bare metal stent implantation.

Original languageEnglish
Pages (from-to)468-475
Number of pages8
JournalCirculation: Cardiovascular Interventions
Volume3
Issue number5
DOIs
Publication statusPublished - Oct 1 2010

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All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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