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

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• 作者：Joo Myung Lee^a ; ¹ ; ² ; Tae-Min Rhee^b ; ¹ ; ² ; Joo-Yong Hahn^a ; ¹ ; Doyeon Hwang^b ; ¹ ; Jonghanne Park^b ; ¹ ; Kyung Woo Park^b ; ¹ ; Hack-Lyoung Kim^c ; ¹ ; Sang-Hyun Kim^c ; ¹ ; In-Ho Chae^d ; ¹ ; Joon-Hyung Doh^e ; ¹ ; Ki-Hyun Jeon^f ; ¹ ; Young Jin Choi^f ; ¹ ; Jin Sik Park^f ; ¹ ; Seung-Hyuck Choi^a ; ¹ ; Hyeon-Cheol Gwon^a ; ¹ ; Bon-Kwon Koo^b ; ¹ ; Fernando Alfonso^g ; ¹ ; Hyo-Soo Kim^b ; ¹ ; ^{hyosoo@snu.ac.kr}
• 关键词：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
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：1 March 2017
• 年：2017
• 卷：230
• 期：Complete
• 页码：181-190
• 全文大小：1443 K
• 卷排序：230

文摘

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.MethodsPatient-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.ResultsA 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.ConclusionsIn 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.