Comparison of outcomes after treatment of in-stent restenosis using newer generation drug-eluting stents versus drug-eluting balloon: Patient-level pooled analysis of Korean Multicenter in-Stent Restenosis Registry. (1st March 2017)

• Record Type: Journal Article
• Authors: Lee, Joo Myung; Rhee, Tae-Min; Hahn, Joo-Yong; Hwang, Doyeon; Park, Jonghanne; Park, Kyung Woo; Kim, Hack-Lyoung; Kim, Sang-Hyun; Chae, In-Ho; Doh, Joon-Hyung; Jeon, Ki-Hyun; Choi, Young Jin; Park, Jin Sik; Choi, Seung-Hyuck; Gwon, Hyeon-Cheol; Koo, Bon-Kwon; Alfonso, Fernando; Kim, Hyo-Soo
• Is Part Of: International journal of cardiology. Volume 230(2017)
• Page Start: 181
• Page End: 190
• Publication Date: 2017-03-01
• Subjects: ACS acute coronary syndrome -- ARC Academic Research Consortium -- BD-DES biodurable polymer coated drug-eluting stent -- BR-DES bioresorbable polymer coated drug eluting stent -- BMS bare metal stent -- CVA cerebrovascular accidents -- DEB drug-eluting balloon -- DES drug-eluting stent -- EES everolimus eluting stent -- IPW inverse probability weighting -- ISR in-stent restenosis -- PCI percutaneous coronary intervention -- POCO patient-oriented composite outcome -- ST stent thrombosis -- TLF target lesion failure -- TLR target lesion revascularization; In-stent restenosis -- Restenosis -- Drug-eluting balloon -- Drug-coated balloon -- Drug-eluting stent -- Percutaneous coronary intervention; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.12.176
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Studies comparing the drug-eluting balloon (DEB) with contemporary drug-eluting stent (DES) in the treatment of in-stent restenosis (ISR) have been scarce. We compared that the efficacy and safety of contemporary DES versus DEB in unselected, real world patients of ISR occurred in bare-metal stent or DES. Methods: Patient-level pooled analysis from nationwide multicenter registries was performed with 628 consecutive patients who underwent ISR treatment using 2nd or 3rd generation DES or DEB. Target lesion failure (TLF) and patient-oriented composite outcomes (POCO, composite of all-cause mortality, all-cause myocardial infarction, or any revascularization) at 1-year follow-up were compared between the DES and DEB groups. Results: A total of 628 patients with 697 ISR lesions were treated using newer generation DES ( n = 409) or DEB ( n = 219). About 55.1% presented with acute coronary syndrome, and 15.1% showed left ventricular dysfunction. The risks of TLF and POCO were significantly lower in the DES group, even after being adjusted by an inverse probability weighted model (TLF, 9.2% vs. 17.9%, HRadjust 0.22, 95% CI 0.11–0.47; POCO, 12.4% vs. 24.1%, HRadjust 0.25, 95% CI 0.13–0.48, all p -values < 0.001), mainly driven by the significantly lower risk of target lesion revascularization (TLR) (7.6% vs. 13.0%, HRadjust 0.21, 95% CI 0.09–0.49, p < 0.001). Treatment of ISR with DEB independently predicted TLF (HR 1.87, 95% CI 1.05–3.02, p = 0.034) along with multi-vessel disease, chronic kidney disease, type B2 or C lesion, and number of treated lesion > 1. Conclusions: In unselected patients of ISR, clinical outcome at one year was mainly dependent on difference in TLR and found to be better with contemporary DES than DEB.