Outcome Differences With the Use of Drug-Eluting Stents for the Treatment of In-Stent Restenosis of Bare-Metal Stents Versus Drug-Eluting Stents

Steinberg, Daniel; Gaglia, Michael A.; Slottow, Tina L. Pinto; Roy, Probal; Bonello, Laurent; Labriolle, Axel de; Lemesle, Gilles; Torguson, Rebecca; Kineshige, Kimberly A; Zhang, Xue; Suddath, William O.; Kent, Kenneth M.; Satler, Lowell F.; Pichard, Augusto D.; Lindsay, Joseph; Waksman, Ron

doi:10.1016/j.amjcard.2008.09.107

Cited by 92 publications

(71 citation statements)

References 23 publications

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“…The higher frequency and duration of medical therapy (aspirin, clopidogrel, and statin) compared to previous studies may also contribute to the decreased TVR rate. Despite the differences in the follow-up length and the patient race, results of the present study are consistent with two recent reports, which also documented worse outcomes in DES-ISR patients than in BMS-ISR patients after undergoing DES-sandwich treatment (Whan Lee et al, 2008;Steinberg et al, 2009).…”

Section: Discussionsupporting

confidence: 82%

Efficacy and safety of drug-eluting stent implantation for the treatment of in-stent restenosis occurring within bare-metal stent and drug-eluting stent

Zhang

Zhou

et al. 2010

J. Zhejiang Univ. Sci. B

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Abstract:Objective: Although drug-eluting stent (DES) implantation is the primary treatment modality for bare-metal stent (BMS) in-stent restenosis (ISR), little is known about the efficacy and safety profile of DES in the treatment of DES-ISR. The goal of this study was to compare the clinical outcomes following DES treatment for BMS-ISR and DES-ISR. Methods: Rates of major adverse cardiac events (MACE) were compared in 97 consecutive patients who underwent DES implantation for the treatment of ISR (56 BMS-ISR and 41 DES-ISR) from January 2004 to December 2008. Results: Baseline clinical and procedural characteristics were comparable, except that the DES used in the BMS-ISR group was longer and had a larger diameter. The length of follow-up was (28.60±1.96) and (20.34±1.54) months for the BMS-ISR and DES-ISR groups, respectively. One patient (1.8%) experienced non-cardiac mortality and one (1.8%) had target-vessel revascularization (TVR) in the BMS-ISR group. In the DES-ISR group, three patients (7.3%) died of sudden death with a documented acute ST-segment elevation myocardial infarction, and three suffered TVR (7.3%). Kaplan-Meier analysis indicated that cumulative survival probability and MACE-free probability were both significantly lower for the DES-ISR group (log rank test P=0. 047 and P=0.005, respectively). In Cox regression analysis, DES-ISR remained an independent predictor for future MACE occurrence after adjustment for other factors (compared with BMS-ISR, risk ratio (RR)=8.743, 95% confidence interval (CI) 1. 54-49.54, P=0.014). Switching to a different type of DES to treat DES-ISR did not improve the prognosis. Conclusion: DES-ISR patients had a poorer prognosis than BMS-ISR patients after DES therapy.

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Section: Discussionsupporting

confidence: 82%

Efficacy and safety of drug-eluting stent implantation for the treatment of in-stent restenosis occurring within bare-metal stent and drug-eluting stent

Zhang

Zhou

et al. 2010

J. Zhejiang Univ. Sci. B

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“…[33][34][35] Because there is currently no effective recommended treatment for such cases, simple balloon dilatation of restenotic tissue could be a major treatment strategy. Therefore, we examined the response to BA of vessels in ISR lesions based on OCT.…”

Section: Response To Ba In Isr Lesionsmentioning

confidence: 99%

Qualitative and Quantitative Assessment of Stent Restenosis by Optical Coherence Tomography

Nagoshi

Shinke

Otake

et al. 2013

Circ J

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“…Current European Society of Cardiology/European Association for Cardiothoracic Surgery (ESC/EACTS) guidelines recommend drug-eluting balloon (DEB) and DES as class IA recommendations for the treatment of BMS or DES-ISR (7). However, most previous studies, which evaluated DEB as a treatment option for ISR, compared its safety and efficacy to first generation DES, which is no longer used in daily clinical practice (1,(8)(9)(10)(11)(12). Our network meta-analysis also shared the common limitation.…”

mentioning

confidence: 90%

Treatment for in-stent restenosis: patient-specific decision rather than universal recommendation

Lee¹,

Park²,

Rhee³

et al. 2016

J. Thorac. Dis.

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The development of the drug-eluting stent (DES) created a milestone in the field of percutaneous coronary intervention (PCI) by markedly reducing the rates of in-stent restenosis (ISR) compared to the bare metal stent (BMS). The development of a thinner strut and biocompatible or bioresorbable polymer coating in newer generation DES has enhanced the efficacy and safety of DES. However, along with the widespread use of this newer generation DES in most clinical conditions, including high-risk patients with more complicated lesion profiles, ISR has continued to be a major concern, even in the era of newer generation DES (1). The incidence of ISR ranges from 3% up to 20% of patients (1). The clinical importance of ISR should be further emphasized, since more than half of ISR patients present with acute coronary syndromes (ACS) such as unstable angina or acute myocardial infarction (1), and patients who have been treated for ISR consistently show higher rates of future adverse cardiovascular events compared to those without ISR (2). In this regards, decision regarding optimal treatment option for ISR lesion should be considered even in contemporary era of PCI using newer generation DES. In order to address this issue, our group recently published the first network meta-analysis which compared clinical and angiographic outcomes among DES, DEB, and plain old balloon angioplasty (POBA). As specifically discussed in the previous editorials (3-6), our group firstly presented the superior efficacy and safety of DEB and DES, compared with POBA, and comparable efficacy and safety between DEB and DES to treat BMS or DES ISR lesion. Although DEB and DES showed similar risk of MI, DEB tended to show lower risk of MI during follow-up period, compared with DES. Although the network meta-analysis by our group comprehensively summarized previous evidences from 11 randomized controlled trials (RCTs) with 2,059 patients with BMS or DES ISR, some unsolved issues are worth to be discussed.First, it should be considered that there has been relatively scarce evidence which evaluated newer generation DES as treatment option for ISR. Current European Society of Cardiology/European Association for Cardiothoracic Surgery (ESC/EACTS) guidelines recommend drug-eluting balloon (DEB) and DES as class IA recommendations for the treatment of BMS or DES-ISR (7). However, most previous studies, which evaluated DEB as a treatment option for ISR, compared its safety and efficacy to first generation DES, which is no longer used in daily clinical practice (1,(8)(9)(10)(11)(12). Our network meta-analysis also shared the common limitation. Among the included trials, 6 out of 7 RCTs which had a DES arm to treat ISR in the previous network metaanalysis, actually used old-fashioned 1 st generation DES such as sirolimus-eluting or paclitaxel-eluting stents. Among the included RCTs, only the RIBS-V trial used 2 nd generation everolimus-eluting stent (Xience Prime, EES) which has been proved to be superior to 1 st generation DES (13).In the RIBS-V trial, DES w...

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Outcome Differences With the Use of Drug-Eluting Stents for the Treatment of In-Stent Restenosis of Bare-Metal Stents Versus Drug-Eluting Stents

Cited by 92 publications

References 23 publications

Efficacy and safety of drug-eluting stent implantation for the treatment of in-stent restenosis occurring within bare-metal stent and drug-eluting stent

Efficacy and safety of drug-eluting stent implantation for the treatment of in-stent restenosis occurring within bare-metal stent and drug-eluting stent

Qualitative and Quantitative Assessment of Stent Restenosis by Optical Coherence Tomography

Treatment for in-stent restenosis: patient-specific decision rather than universal recommendation

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