Drug-eluting balloon angioplasty for in-stent restenosis: a systematic review and meta-analysis of randomised controlled trials. Issue 5 (18th January 2013)

• Record Type: Journal Article
• Authors: Indermuehle, Andreas; Bahl, Rahul; Lansky, Alexandra J; Froehlich, Georg M; Knapp, Guido; Timmis, Adam; Meier, Pascal
• Is Part Of: Heart. Volume 99:Issue 5(2013)
• Page Start: 327
• Page End: 333
• Publication Date: 2013-01-18
• Subjects: Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2012-302945
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Context: The optimal treatment option for in-stent restenosis is currently unclear. Objective: Systematic review and meta-analysis of the effect of drug-eluting balloons (DEB) to treat in-stent restenosis. Data sources: Trials were identified through a literature search from 2005 through 7 November 2012. Study selection: Randomised clinical trials comparing DEB with a control treatment (plain balloon angioplasty or drug-eluting stents). Data extraction and synthesis: Main endpoints of interest were major adverse cardiac events (MACE), target lesion revascularisation (TLR), binary in-segment restenosis, stent thrombosis (ST), myocardial infarction (MI) and mortality. A random-effects model was used to calculate the pooled relative risks (RR) with 95% CIs. Results: Five studies and a total of 801 patients were included in this analysis. Follow-up duration ranged from 12 to 60months. Most endpoints were significantly reduced for DEB compared with the control groups. For MACE, the relative risk RR was 0.46 (0.31 to 0.70), p<0.001, for TLR it was 0.34 (0.16 to 0.73); p=0.006, for angiographic in-segment restenosis it was 0.28 (0.14 to 0.58); p<0.001. There was a lower mortality for DEB (RR 0.48 (0.24 to 0.95); p=0.034). The incidence of MI was numerically lower, but the differences were not statistically significant (RR 0.68 (0.32 to 1.48); p=0.337). There was no difference in the risk of ST (RR 1.12 (0.23 to 5.50), p=0.891). Conclusions: In-stent restenosis is the bane of coronary angioplasty, and drug-eluting balloon angioplasty is a promising treatment option in this situation. It reduces the risk for MACE compared with plain balloon angioplasty or implantation of a Taxus Liberte drug-eluting stent.