Coronary disease & ACSCohort study
Contemporary Trends for the Treatment of In-Stent Restenosis in the United States, 2009 to 2024
- Registry analysis
- National Cardiovascular Data Registry CathPCI Registry
- Multivariable logistic regression clustered by operator
Authors' conclusion
ISR remains a major contributor to percutaneous coronary intervention volume. Use of adjunctive plaque-modification devices, especially intravascular lithotripsy, has risen sharply. Adjunctive therapy was associated with higher in-hospital event rates, likely reflecting lesion complexity.
Study context
- Population
- In-stent restenosis (ISR) percutaneous coronary intervention procedures in the National Cardiovascular Data Registry CathPCI Registry from July 2009 to June 2024ISR admissions (1,182,599 lesions)
- Participants
- 1,065,354 procedures
- Exposure
- Adjunctive ISR therapy vs Conventional plain old balloon angioplasty
Main finding
As reported in the abstract
Use of adjunctive devices
Adjunctive devices used in cases
26.5%
2018 Q1
20.8%
2024 Q2
40.7%
Intravascular lithotripsy within 4 years of US introduction
16.1%
Observational data: associations, not effects.
Further findings
Recurrent ISR
- Recurrent ISR
- 14.3%
- Managed with adjunctive therapy, recurrent ISR
- 34.2%
- Managed with adjunctive therapy, initial ISR
- 25.0%
- Recurrent ISR had lower absolute complication rates
Safety
| Outcome | odds ratio (95% CI) | |
|---|---|---|
| In-hospital mortality, myocardial infarction, bleeding, stroke — Adjunctive ISR therapy vs Conventional plain old balloon angioplasty · in-hospital mortality; higher odds with adjunctive therapy | 1.25 (1.19–1.31) | |
| In-hospital mortality, myocardial infarction, bleeding, stroke — Adjunctive ISR therapy vs Conventional plain old balloon angioplasty · myocardial infarction | 1.30 (1.24–1.35) | |
| In-hospital mortality, myocardial infarction, bleeding, stroke — Adjunctive ISR therapy vs Conventional plain old balloon angioplasty · bleeding | 1.29 (1.26–1.33) | |
| In-hospital mortality, myocardial infarction, bleeding, stroke — Adjunctive ISR therapy vs Conventional plain old balloon angioplasty · stroke | 1.11 (1.02–1.22) | |
| 0.512Odds ratio (log scale) |
- In-hospital mortality, myocardial infarction, bleeding, stroke: adjusted, multivariable logistic regression clustered by operator
Original publication
Contemporary Trends for the Treatment of In-Stent Restenosis in the United States, 2009 to 2024. Circ Cardiovasc Interv. Published 10 September 2026. doi:10.1161/circinterventions.126.016533
Summarised from the published abstract; every number is checked against it