Safety and efficacy of limus-eluting stents and balloon angioplasty for sirolimus-eluting in-stent restenosis.
Safety and efficacy of limus-eluting stents and balloon angioplasty for sirolimus-eluting in-stent restenosis.
Available in print through MWHC library: 2002 - present
BACKGROUND: The optimal treatment for drug-eluting in-stent restenosis remains controversial. CONCLUSIONS: In patients presenting with S-ISR, treatment with implantation of an EES, SES, or POBA is associated with similar clinical outcomes. Patients presenting with recurrent ISR may have a poorer clinical outcome.Copyright � 2015 Elsevier Inc. All rights reserved. METHODS: The study cohort comprised 310 consecutive patients (444 lesions) who presented with S-ISR to our institution and underwent treatment with EES (43 patients), SES (102), or POBA (165). The analyzed clinical parameters were the 1-year rates of death, Q-wave myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), definite stent thrombosis (ST) and major adverse cardiac event (MACE) defined as the composite of death, MI, or TLR at 1-year. OBJECTIVES: The aim of this study was to compare the safety and efficacy of everolimus-eluting stent (EES), sirolimus-eluting stent (SES), and plain old balloon angioplasty (POBA) for the treatment of SES in-stent restenosis (S-ISR). RESULTS: The three groups were well matched for the conventional risk factors for coronary artery disease except for smoking. The 1-year analyzed clinical parameters were similar in the three groups: MACE (EES=14%, SES=18%, POBA=20%; p=0.65), death (EES=2.3%, SES=6.2%, POBA=6.1%; p=0.61), MI (EES=4.8%, SES=2.1%, POBA=2.5%; p=0.69), TLR (EES=11.9%, SES=12.1%, POBA=24%; p=0.78), and TVR (EES=11.9%, SES=24.8%, POBA=22.2%; p=0.23). There were no cases of definite ST. MACE-free rate was significantly lower in patients with recurrent in-stent restenosis (log-rank p=0.006). Presentation with acute MI, number of treated lesions and a previous history of MI were found to be independent predictors of MACE.
English
1878-0938
*Angioplasty, Balloon, Coronary/ae [Adverse Effects]
*Coronary Restenosis/th [Therapy]
*Coronary Stenosis/th [Therapy]
*Drug-Eluting Stents/ae [Adverse Effects]
*Everolimus/pd [Pharmacology]
*Sirolimus/pd [Pharmacology]
Aged
Angioplasty, Balloon, Coronary/mt [Methods]
Cohort Studies
Confidence Intervals
Coronary Angiography/mt [Methods]
Coronary Restenosis/mo [Mortality]
Coronary Restenosis/ra [Radiography]
Coronary Stenosis/mo [Mortality]
Coronary Stenosis/ra [Radiography]
Female
Follow-Up Studies
Humans
Male
Middle Aged
Multivariate Analysis
Patient Safety
Proportional Hazards Models
Retreatment
Retrospective Studies
Risk Assessment
Statistics, Nonparametric
Survival Rate
Time Factors
Treatment Outcome
MedStar Heart & Vascular Institute
Comparative Study
Evaluation Studies
Journal Article
Available in print through MWHC library: 2002 - present
BACKGROUND: The optimal treatment for drug-eluting in-stent restenosis remains controversial. CONCLUSIONS: In patients presenting with S-ISR, treatment with implantation of an EES, SES, or POBA is associated with similar clinical outcomes. Patients presenting with recurrent ISR may have a poorer clinical outcome.Copyright � 2015 Elsevier Inc. All rights reserved. METHODS: The study cohort comprised 310 consecutive patients (444 lesions) who presented with S-ISR to our institution and underwent treatment with EES (43 patients), SES (102), or POBA (165). The analyzed clinical parameters were the 1-year rates of death, Q-wave myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), definite stent thrombosis (ST) and major adverse cardiac event (MACE) defined as the composite of death, MI, or TLR at 1-year. OBJECTIVES: The aim of this study was to compare the safety and efficacy of everolimus-eluting stent (EES), sirolimus-eluting stent (SES), and plain old balloon angioplasty (POBA) for the treatment of SES in-stent restenosis (S-ISR). RESULTS: The three groups were well matched for the conventional risk factors for coronary artery disease except for smoking. The 1-year analyzed clinical parameters were similar in the three groups: MACE (EES=14%, SES=18%, POBA=20%; p=0.65), death (EES=2.3%, SES=6.2%, POBA=6.1%; p=0.61), MI (EES=4.8%, SES=2.1%, POBA=2.5%; p=0.69), TLR (EES=11.9%, SES=12.1%, POBA=24%; p=0.78), and TVR (EES=11.9%, SES=24.8%, POBA=22.2%; p=0.23). There were no cases of definite ST. MACE-free rate was significantly lower in patients with recurrent in-stent restenosis (log-rank p=0.006). Presentation with acute MI, number of treated lesions and a previous history of MI were found to be independent predictors of MACE.
English
1878-0938
*Angioplasty, Balloon, Coronary/ae [Adverse Effects]
*Coronary Restenosis/th [Therapy]
*Coronary Stenosis/th [Therapy]
*Drug-Eluting Stents/ae [Adverse Effects]
*Everolimus/pd [Pharmacology]
*Sirolimus/pd [Pharmacology]
Aged
Angioplasty, Balloon, Coronary/mt [Methods]
Cohort Studies
Confidence Intervals
Coronary Angiography/mt [Methods]
Coronary Restenosis/mo [Mortality]
Coronary Restenosis/ra [Radiography]
Coronary Stenosis/mo [Mortality]
Coronary Stenosis/ra [Radiography]
Female
Follow-Up Studies
Humans
Male
Middle Aged
Multivariate Analysis
Patient Safety
Proportional Hazards Models
Retreatment
Retrospective Studies
Risk Assessment
Statistics, Nonparametric
Survival Rate
Time Factors
Treatment Outcome
MedStar Heart & Vascular Institute
Comparative Study
Evaluation Studies
Journal Article