title: Sirolimus-eluting stent versus balloon angioplasty for sirolimus-eluting stent restenosis: Insights from the j-Cypher Registry.
abstract: BACKGROUND
  Optimal treatment strategies for restenosis of sirolimus-eluting stents (SES) have not been adequately addressed yet.
  
  
  RESULTS
  During the 3-year follow-up of 12 824 patients enrolled in the j-Cypher registry, 1456 lesions in 1298 patients underwent target-lesion revascularization (TLR). Excluding 362 lesions undergoing TLR for stent thrombosis or TLR using treatment modalities other than SES or balloon angioplasty (BA), 1094 lesions with SES-associated restenosis in 990 patients treated with either SES (537 lesions) or BA (557 lesions) constituted the study population for the analysis of recurrent TLR and stent thrombosis after the first TLR. Excluding 24 patients with both SES- and BA-treated lesions, 966 patients constituted the analysis set for the mortality outcome. Cumulative incidence of recurrent TLR in the SES-treated restenosis lesions was significantly lower than that in the BA-treated restenosis lesions (23.8% versus 37.7% at 2 years after the first TLR; P<0.0001). Among 33 baseline variables evaluated, only hemodialysis was identified to be the independent risk factor for recurrent TLR by a multivariable logistic regression analysis. After adjusting for confounders, repeated SES implantation was associated with a strong treatment effect in preventing recurrent TLR over BA (odds ratio, 0.44; 95% confidence interval, 0.32 to 0.61; P<0.0001). The 2-year mortality and stent thrombosis rates between the SES- and the BA-treated groups were 10.4% versus 10.8% (P=0.4) and 0.6% versus 0.6%, respectively.
  
  
  CONCLUSIONS
  Repeated implantation of SES for SES-associated restenosis is more effective in preventing recurrent TLR than treatment with BA, without evidence of safety concerns.
authors.affiliation: National Cardiovascular Center, Suita, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Abe
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Takuya
authors.initials: T
authors.lastname: Taniguchi
authors.forename: Futoshi
authors.initials: F
authors.lastname: Yamanaka
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Nakao
authors.forename: Nobuhito
authors.initials: N
authors.lastname: Yagi
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Kokubu
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Kasahara
authors.forename: Yu
authors.initials: Y
authors.lastname: Kataoka
authors.forename: Yoritaka
authors.initials: Y
authors.lastname: Otsuka
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kawamura
authors.forename: Shunichi
authors.initials: S
authors.lastname: Miyazaki
authors.forename: Koichi
authors.initials: K
authors.lastname: Nakao
authors.forename: Kenji
authors.initials: K
authors.lastname: Horiuchi
authors.forename: Akira
authors.initials: A
authors.lastname: Ito
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hoshizaki
authors.forename: Ren
authors.initials: R
authors.lastname: Kawaguchi
authors.forename: Manabu
authors.initials: M
authors.lastname: Setoguchi
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Inada
authors.forename: Koichi
authors.initials: K
authors.lastname: Kishi
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sakamoto
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Morioka
authors.forename: Masao
authors.initials: M
authors.lastname: Imai
authors.forename: Hiroki
authors.initials: H
authors.lastname: Shiomi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nonogi
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Mitsudo
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D023903:Coronary Restenosis / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000453:epidemiology; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D011446:Prospective Studies; D012042:Registries; D006435:Renal Dialysis / Q000009:adverse effects; D012307:Risk Factors; D055502:Secondary Prevention; D020123:Sirolimus / Q000627:therapeutic use*
chemical_list: D020123:Sirolimus