Derivation and validation of the ISAR score to predict the risk of repeat percutaneous coronary intervention for recurrent drug-eluting stent restenosis.

Coughlan, J J; Aytekin, Alp; Lahu, Shqipdona; Scalamogna, Maria; Wiebe, Jens; Pinieck, Susanne; Kufner, Sebastian; Xhepa, Erion; Joner, Michael; Kuna, Constantin; Voll, Felix; Laugwitz, Karl Ludwig; Schunkert, Heribert; Kastrati, Adnan; Cassese, Salvatore

doi:10.4244/EIJ-D-22-00860

journal article

Title:: Derivation and validation of the ISAR score to predict the risk of repeat percutaneous coronary intervention for recurrent drug-eluting stent restenosis.
Document type:: Randomized Controlled Trial; Journal Article
Author(s):: Coughlan, J J; Aytekin, Alp; Lahu, Shqipdona; Scalamogna, Maria; Wiebe, Jens; Pinieck, Susanne; Kufner, Sebastian; Xhepa, Erion; Joner, Michael; Kuna, Constantin; Voll, Felix; Laugwitz, Karl Ludwig; Schunkert, Heribert; Kastrati, Adnan; Cassese, Salvatore
Abstract:: BACKGROUND: The treatment of drug-eluting stent (DES) in-stent restenosis (ISR) is challenging as it has a high risk of recurrence. AIMS: The aim of this analysis was to develop and validate a model to predict the risk of repeat percutaneous coronary intervention (PCI) for recurrent DES-ISR. METHODS: A retrospective, observational analysis was performed including consecutive patients treated with PCI for DES-ISR at two centres in Germany. Included patients were randomly divided into training and validation cohorts. Two regression analyses identified factors associated with repeat PCI for recurrent DES-ISR up to 1 year. The discriminative ability of the resultant model was then compared to a benchmark ISR classification model using bootstrap resampling. A classification and regression tree analysis and a numerical scoring system (the ISAR score) were used to predict the risk of repeat PCI for recurrent DES-ISR based on the identified predictors. RESULTS: We included 1,986 patients in the current analysis, divided randomly into training (1,471 patients, 1,778 lesions) and validation (515 patients, 614 lesions) cohorts. Four factor variables (a non-focal ISR pattern, a time interval to ISR of <6 months, ISR of the left circumflex artery and ISR in a calcified vessel) were associated with repeat PCI for recurrent DES-ISR at 1-year follow-up. On bootstrap resampling analysis, the C-statistic for the model including these four variables was 0.60 (95% confidence interval [CI]: 0.57-0.63), whereas the C-statistic for the benchmark ISR classification model was 0.54 (95% CI: 0.52-0.57), a difference that was statistically significant (delta C-statistic 0.062; 95% CI: 0.035-0.094; p<0.001). The cumulative incidence of repeat PCI for recurrent DES-ISR was over three times higher in DES-ISR lesions with an ISAR score of ≥3 in comparison to lesions with an ISAR score of 0. CONCLUSIONS: This study developed and validated a risk prediction model for repeat PCI for recurrent DES-ISR at 1-year follow-up. This model served to generate the ISAR score, a standardised tool that can be used to predict the 1-year risk of repeat PCI for recurrent DES-ISR.
Journal title abbreviation:: EuroIntervention
Year:: 2023
Journal volume:: 18
Journal issue:: 16
Pages contribution:: e1328-e1338
Fulltext / DOI:: doi:10.4244/EIJ-D-22-00860
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/36785947
Print-ISSN:: 1774-024X
TUM Institution:: Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (DHM) (Prof. Schunkert); Klinik und Poliklinik für Innere Medizin I, Kardiologie (Prof. Laugwitz)
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Occurrences:

mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (DHM) (Prof. Schunkert)2023

mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Klinik und Poliklinik für Innere Medizin I, Kardiologie (Prof. Laugwitz)2023