Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 8 1 2015 10 11 14 20 EN Negar Faramarzi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mojtaba Salarifar Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Seyed Ebrahim Kassaian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Ali Mohammad Haji-Zeinali Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Alidoosti Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Hamidreza Pourhoseini Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Ebrahim Nematipour Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Reza Mousavi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Hamidreza Goodarzynejad Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 10 2015 10 10 Background: Despite major advances in percutaneous coronary intervention (PCI), in-stent restenosis (ISR) remains a therapeutic challenge. We sought to compare the mid-term clinical outcomes after treatment with repeat drug-eluting stent (DES) implantation (“DES sandwich” technique) with DES placement in the bare-metal stent (DES-in-BMS) in a "real world" setting. Methods: We retrospectively identified and analyzed clinical and angiographic data on 194 patients previously treated with the DES who underwent repeat PCI for ISR with a DES or a BMS. ISR was defined, by visual assessment, as a luminal stenosis greater than 50% within the stent or within 5 mm of its edges. We recorded the occurrence of major adverse cardiac events (MACE), defined as cardiac death, non-fatal myocardial infarction, and the need for target vessel revascularization (TVR). Results: Of the 194 study participants, 130 were men (67.0%) and the mean ± SD of age was 57.0 ± 10.4 years, ranging from37 to 80 years. In-hospital events (death and Q-wave myocardial infarction) occurred at a similar frequency in both groups. Outcomes at twelve months were also similar between the groups with cumulative clinical MACE at one-year follow-up of 9.6% and 11.3% in the DES-in-BMS and the DES-in-DES groups, respectively (p value = 0.702). Although not significant, there was a trend toward a higher TVR rate in the intra-DES ISR group as compared to the intra-BMS ISR group (0.9% BMS vs. 5.2% DES; p value = 0.16). Conclusion: Our study suggests that the outcome of the patients presenting with ISR did not seem to be different between the two groups of DES-in-DES and DES-in-BMS at one-year follow-up, except for a trend toward more frequent TVR in the DES-in-DES group. Repeat DES implantation for DES restenosis could be feasible and safe with a relatively low incidence of MACE at mid-term follow-up. https://rhythm.tums.ac.ir/index.php/jthc/article/view/276 https://rhythm.tums.ac.ir/index.php/jthc/article/download/276/269