Clinical profile and angiographic patterns of patients undergoing treatment for in-stent restenosis and outcomes associated with the treatment

Context: The optimal treatment strategy for in-stent restenosis (ISR) still remains under debate. Moreover, there have been scarce data on Indian patients relating to ISR treatment. Aim: The aim of this study was to determine the clinical profile and angiographic pattern of patients with ISR and to evaluate the outcome of these patients being treated for ISR. Settings and Design: This was a cross-sectional study which consisted of patients who had coronary angiographic characteristic of ISR. Materials and Methods: Patients were divided into subgroups as per presentation, acute coronary syndrome (ACS), and non-ACS. After the ISR event and treatment, the patients were followed up for a minimum period of 6 months for any adverse events. The primary outcome of the study was occurrence of a major adverse cardiac event. Statistical Analysis: Chi-square test, Fisher's exact test, Student's t-test, or Mann–Whitney test was applied according to type and distribution of variable (SPSS software). Results: One hundred patients with 109 culprit lesions of ISR were included in the study. The ACS was dominant clinical presentation mode, occurring in 62 patients. Fifty-four percent of the patients were treated with percutaneous coronary intervention, 26% were managed with coronary artery bypass grafting, and 19% were treated with optimized medical therapy. Majority of the adverse events (12 out of 15 patients) occurred in the ACS group, with a statistically significant difference at 6-month follow-up (P = 0.021). Conclusion: Patients with ISR have ACS as the most common mode of presentation. Patients with ISR presenting with ACS are at high risk and must be closely monitored. The treatment of ISR with drug-eluting stent or drug-coated balloon is most effective.