Repeat percutaneous coronary revascularization: indications and outcomes in a "real world" cohort

David Adlam, Nicholas Evans, Aneil Malhotra, Disha Midha, Felicity Rowley, David Hutchings, Mirae Shin, Guy Mole, Alexander Stockenhuber, Mark Lumb, Jonathan Wordsworth, Sophie Frantal, J Colin Forfar

Research output: Contribution to journalArticlepeer-review


OBJECTIVES: To investigate rates of and reasons for second and subsequent stent procedures in an unselected, "real-world" population.

BACKGROUND: Repeat stenting is the primary difference reported in clinical trials of alternative revascularization strategies. The incidence, indication, and outcome for repeat stenting in contemporary practice outside the more selective populations of trials and registries has not been described.

METHOD: All patients undergoing a first percutaneous coronary intervention (PCI) procedure with stenting from January 2001 to August 2009 (10,509) from a large UK tertiary referral and district general hospital were identified. Mortality and the incidence, timing, and indication for repeat revascularization in this population were investigated from patient records.

RESULTS: Of 10,509 patients undergoing a first PCI and stent implant 23.5% underwent repeat angiography of which 11.2% required repeat PCI and 2% coronary artery bypass grafting (median follow-up of 3.8 years). A total of 1.3% went on to a third PCI. The commonest indication for repeat stenting was disease progression remote from the original stent (46%) and planned staged PCI (23%); 21% had a stent-related indication. Functional assessment before repeat stenting was used in one-third of stable patients. Mortality was 2.5% per annum.

CONCLUSIONS: In contemporary practice, patients undergoing a first stenting procedure have a low subsequent mortality, and the substantial majority (86.4%) requires no further revascularization over a median 3.8 year follow-up. For those who do require repeat stenting, this is most commonly at a site remote from the first stent.

Original languageEnglish
Pages (from-to)539-545
Number of pages7
JournalCatheterization and Cardiovascular Interventions
Issue number4
Publication statusPublished - 1 Oct 2012


  • Adult
  • Aged
  • Aged, 80 and over
  • Coronary Artery Bypass
  • Coronary Artery Disease/mortality
  • Coronary Restenosis/etiology
  • Coronary Thrombosis/etiology
  • Disease Progression
  • England
  • Female
  • Hospitals, District
  • Hospitals, General
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention/adverse effects
  • Proportional Hazards Models
  • Retreatment
  • Stents
  • Tertiary Care Centers
  • Time Factors
  • Treatment Outcome


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