title: Comparison of sirolimus versus paclitaxel eluting stents for treatment of coronary in-stent restenosis.
abstract: In patients with in-stent restenosis (ISR) inside bare metal stents, drug-eluting stents reduce the recurrence of restenosis compared with balloon angioplasty. However, few data are available about this therapeutic modality in the case of diffuse restenosis. The aim of this study was to evaluate the immediate and mid-term outcome of sirolimus- and paclitaxel-eluting stent implantation in diffuse ISR and determine the predictors of clinical and angiographic restenosis recurrence. A series of 161 consecutive patients with 194 diffuse ISR lesions (>10 mm) treated with drug-eluting stent implantation were evaluated. Major adverse cardiac events were defined as death, myocardial infarction, and the need for target lesion revascularization. During a mean follow-up of 8.2 +/- 3.4 months, the cumulative incidence of major adverse cardiac events was 19% in the SES group and 24% in the PES group (p = 0.56). Angiographic follow-up was performed in 80% of the lesions. The overall restenosis rate was 22% and was not significantly different between lesions treated with sirolimus-eluting (20%) or paclitaxel-eluting (25%, p = 0.55) stents. The incidence of restenosis was higher in diabetics (32%) than in nondiabetics (16%, odds ratio 2.5, 95% confidence interval 1.1 to 5.5, p = 0.02). By multivariate analysis, diabetes was confirmed to be the only independent predictor of recurrent restenosis (odds ratio 3.53, 95% confidence interval 1.39 to 9.02, p = 0.008). In conclusion, drug-eluting stent implantation for diffuse ISR is associated with acceptable clinical and angiographic results. The association of diffuse restenosis and diabetes mellitus is an unfavorable condition leading to a high risk of recurrence.
authors.affiliation: San Raffaele Hospital IRCCS, Milan, Italy.
authors.forename: Flavio
authors.initials: F
authors.lastname: Airoldi
authors.forename: Carlo
authors.initials: C
authors.lastname: Briguori
authors.forename: Ioannis
authors.initials: I
authors.lastname: Iakovou
authors.forename: Goran
authors.initials: G
authors.lastname: Stankovic
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: Mauro
authors.initials: M
authors.lastname: Carlino
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: Matteo
authors.initials: M
authors.lastname: Montorfano
authors.forename: John
authors.initials: J
authors.lastname: Cosgrave
authors.forename: Iassen
authors.initials: I
authors.lastname: Michev
authors.forename: Renata
authors.initials: R
authors.lastname: Rogacka
authors.forename: Giuseppe Massimo
authors.initials: GM
authors.lastname: Sangiorgi
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000453:epidemiology / Q000628:therapy*; D019992:Databases as Topic; D003920:Diabetes Mellitus / Q000453:epidemiology; D016503:Drug Delivery Systems; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D017239:Paclitaxel / Q000008:administration & dosage*; D012008:Recurrence; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents
chemical_list: D007166:Immunosuppressive Agents; D017239:Paclitaxel; D020123:Sirolimus