WASHINGTON — Many patients with bare metal stent restenosis have a favorable prognosis, even though they often present with acute coronary syndrome that requires intervention, Dr. Daniel H. Steinberg reported at a symposium that was jointly sponsored by the Washington Hospital Center and the Cardiovascular Research Institute.
Many interventionalists have begun to use more bare-metal stents (BMS) when they are appropriate for revascularization because of concerns over the increased risk of late stent thrombosis that has been associated with the use of drug-eluting stents and the need for prolonged use of dual antiplatelet therapy.
The increased use of BMS “will undoubtedly increase the number of patients with restenosis,” said Dr. Steinberg, a fellow in cardiovascular disease at the Washington Hospital Center.
Recent reports have suggested that restenosis presents as an acute coronary syndrome (ACS) and may be associated with adverse outcomes, so Dr. Steinberg and his colleagues reviewed 2,539 patients who presented with BMS restenosis.
Most (53%) of those patients presented with features of ACS—unstable angina requiring hospitalization (46%) or myocardial infarction (7%)— whereas others had no ischemic symptoms (19%) or had stable exertional angina (28%), Dr. Steinberg stated on a poster that he presented at the symposium.
Both ACS and non-ACS patients had similar mortality at 30 days (1.2% vs. 1%) and at 6 months (3.4% vs. 3.3%). The incidence of MI also was similar at 30 days (1.3% vs. 1.4%) and at 6 months (4.7% vs. 4.3%).
Even though BMS restenosis often presents as an ACS, it “continues to be a relatively benign clinical entity,” he concluded.