title: Outcome differences with the use of drug-eluting stents for the treatment of in-stent restenosis of bare-metal stents versus drug-eluting stents.
abstract: Drug-eluting stent (DES) implantation is the standard treatment for patients with bare-metal stent (BMS) in-stent restenosis (ISR) and is associated with low rates of target-vessel revascularization. Outcomes in patients with DES ISR treated using repeated DES placement are less certain. A total of 119 patients who presented with BMS ISR and 119 patients with DES ISR matched for baseline characteristics were evaluated. Both groups of patients were treated using DESs and compared with regard to major adverse cardiac events, including death, myocardial infarction, and target-vessel revascularization, at 1 year. Baseline characteristics were similar between groups. Compared with patients with BMS ISR, those with DES ISR had similar 1-year rates of death (5.1% BMS ISR vs 3.5% DES ISR; p = 0.75) and myocardial infarction (2.6% BMS ISR vs 3.5% DES ISR; p = 0.72) when treated using DESs. However, at 1 year, patients with DES ISR experienced significantly higher rates of target-vessel revascularization (10.3% BMS ISR vs 22.2% DES ISR; p = 0.01), with a trend toward increased overall major adverse cardiac events, including death, myocardial infarction, and target-vessel revascularization (16.0% BMS ISR vs 25.2% DES ISR; p = 0.08). Stent thrombosis occurred with similar frequency in both groups (2.5% BMS ISR vs 0.8% DES ISR; p = 0.62). In conclusion, DES ISR continues to be a therapeutic challenge because patients with DES ISR treated using DESs experience higher rates of recurrence compared with patients with BMS ISR treated using DESs. The optimal treatment of patients with DES restenosis remains to be defined.
authors.affiliation: Department of Internal Medicine, Washington Hospital Center, Washington, DC, USA.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Steinberg
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gaglia
authors.forename: Tina L
authors.initials: TL
authors.lastname: Pinto Slottow
authors.forename: Probal
authors.initials: P
authors.lastname: Roy
authors.forename: Laurent
authors.initials: L
authors.lastname: Bonello
authors.forename: Axel
authors.initials: A
authors.lastname: De Labriolle
authors.forename: Gilles
authors.initials: G
authors.lastname: Lemesle
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.forename: Kimberly
authors.initials: K
authors.lastname: Kineshige
authors.forename: Zhenyi
authors.initials: Z
authors.lastname: Xue
authors.forename: William O
authors.initials: WO
authors.lastname: Suddath
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Kent
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.forename: Joseph
authors.initials: J
authors.lastname: Lindsay
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003324:Coronary Artery Disease / Q000628:therapy*; D023903:Coronary Restenosis; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome