{
  "abstract": "Background\n\nIn-stent restenosis (ISR) remains a major limitation after percutaneous coronary intervention (PCI) with drug-eluting stents (DESs). However, long-term patency data after chronic total occlusion (CTO) PCI are limited despite high ISR risk. We evaluated long-term ISR incidence and predictors after CTO PCI.Methods\n\nThis prospective single-centre study (NCT07473596) included patients with successful CTO PCI and DES implantation in 2014-2021. Selected survivors underwent protocol-driven surveillance with coronary computed tomography angiography ≥3 years after the index procedure, with suspected ISR confirmed by invasive coronary angiography (ICA). ISR was also identified through clinically indicated ICA during follow-up in all patients. Patient-, lesion-, and procedure-related ISR predictors were analysed.Results\n\nThe study included 294 patients (median age 66 years (IQR 57-74), 79.9% male) and 294 analysed CTO stents. Median clinical and imaging follow-up were 7.1 (IQR 5.1-8.9) and 4.4 (IQR 3.2-6.2) years, respectively. Follow-up imaging covered 186 patients and 186 analysed CTO stents (63.3%). ISR was diagnosed in 40 stents (13.6%). Aalen-Johansen cumulative ISR incidence was 4.8% (95% CI 2.9-7.9), 10.2% (95% CI 7.1-14.5), and 12.9% (95% CI 9.3-18.0) at 3, 5, and 8 years, respectively. Atrial fibrillation (HR 3.71, 95% CI 1.74-7.91, p < 0.001) and in-stent CTO (HR 3.51, 95% CI 1.53-8.04, p = 0.003) were independently associated with ISR.Conclusions\n\nLong-term ISR after CTO PCI was infrequent in this high-risk cohort, although estimates should be interpreted in the context of selected imaging follow-up among survivors. ISR was independently associated with atrial fibrillation and in-stent CTO at the index procedure.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Cardiology, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4 (PL 340), Helsinki, 00029, Finland.",
    "Department of Radiology, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4 (PL 340), Helsinki, 00029, Finland."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Lauri Mansikkaniemi"
    },
    {
      "affs": [
        0
      ],
      "name": "Juhani A Stewart"
    },
    {
      "affs": [
        0
      ],
      "name": "Juha Sinisalo"
    },
    {
      "affs": [
        1
      ],
      "name": "Miia Holmström"
    },
    {
      "affs": [
        0
      ],
      "name": "Petri Laine"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/34tyy85117323.bib",
  "cited_by": 0,
  "doi": "10.1016/j.ijcha.2026.102028",
  "fulltext_url": "https://europepmc.org/articles/PMC13694426",
  "id": "34tyy85117323",
  "issns": [
    "2352-9067"
  ],
  "landing_url": "https://europepmc.org/article/MED/42926761",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2746|Coronary Interventions and Diagnostics"
    ]
  ],
  "openalex": "W7221776176",
  "pdf_url": "https://europepmc.org/articles/PMC13694426?pdf=render",
  "pmcid": "PMC13694426",
  "pmid": "42926761",
  "published": "2026-10-14",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/34tyy85117323.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:21:18Z",
      "native_id": "MED:42926761",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42926761"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Coronary Interventions and Diagnostics",
      "subfield": "surgery"
    }
  ],
  "title": "Long-term incidence and predictors of in-stent restenosis after chronic total occlusion percutaneous coronary intervention: a cohort study.",
  "title_text": "Long-term incidence and predictors of in-stent restenosis after chronic total occlusion percutaneous coronary intervention: a cohort study.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:21:18Z",
  "url": "https://research.draconitic.com/paper/34tyy85117323",
  "venue": "International journal of cardiology. Heart & vasculature",
  "versions": []
}