Comparison of six-month angiographic and three-year outcomes after sirolimus-eluting stent implantation versus brachytherapy for bare metal in-stent restenosis.
To evaluate long-term effectiveness of sirolimus-eluting stent (SES) implantation for diffuse bare metal in-stent restenosis (ISR), we compared 6-month angiographic and long-term (3-year) clinical outcomes of SES implantation and intracoronary brachytherapy (ICBT). SES implantation for diffuse ISR was performed in 120 consecutive patients and their results were compared with those from 240 patients treated with beta-radiation with balloons filled with rhenium-188 and mercaptoacetyltriglycine. The radiation dose was 15 or 18 Gy at a depth of 1.0 mm into the vessel wall. The primary end point was 3-year major adverse cardiac events including myocardial infarction, cardiac death, and target lesion revascularization. The 2 groups were similar in baseline clinical and angiographic characteristics. Lesion lengths were 25.1 +/- 14.2 mm in the SES group and 24.5 +/- 10.4 mm in the ICBT group (p = 0.15). In-stent acute gain was greater in the SES group than in the ICBT group (2.23 +/- 0.62 vs 1.91 +/- 0.54 mm, p <0.001). We obtained 6-month angiographic follow-up in 287 patients (79.7%). In-segment angiographic restenoses were 7.4% (7 of 94) in the SES group and 26.4% (51 of 193) in the ICBT group (p <0.05). Two myocardial infarctions (1 in each group) and 5 deaths (4 in SES group, 1 in ICBT group) occurred during 3-year follow-up. At 3 years, survival rates without target lesion revascularization (94.1 +/- 2.2% vs 84.6 +/- 2.3%, p = 0.011) and major adverse cardiac events (92.5 +/- 2.4% vs 84.2 +/- 2.4%, respectively, p = 0.03) were higher in the SES than in the ICBT group. In conclusion, compared with ICBT, SES implantation for diffuse ISR is more effective in decreasing recurrent restenosis and improving long-term outcomes.
Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Seung-Whan
SW
Lee
Seong-Wook
SW
Park
Duk-Woo
DW
Park
Se-Whan
SW
Lee
Sang-Hyun
SH
Kim
Jae-Sik
JS
Jang
Yeong-Hoon
YH
Jeong
Young-Hak
YH
Kim
Cheol Whan
CW
Lee
Myeong-Ki
MK
Hong
Seong-Chul
SC
Yun
Jae-Joong
JJ
Kim
Seung-Jung
SJ
Park
D001918:Brachytherapy; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000532:radiotherapy / Q000628:therapy*; D003331:Coronary Vessels; D005260:Female; D005998:Glycine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011868:Radioisotopes / Q000627:therapeutic use; D011879:Radiotherapy Dosage; D012211:Rhenium / Q000627:therapeutic use; D020123:Sirolimus; D015607:Stents; D016896:Treatment Outcome
D011868:Radioisotopes; C096273:N-(mercaptoacetyl)glycine; D012211:Rhenium; D005998:Glycine; D020123:Sirolimus