title: Drug-eluting stents vs. intracoronary brachytherapy for in-stent restenosis: a meta-analysis.
abstract: BACKGROUND
  It has been reported that drug-eluting stents (DES) were superior to intracoronary brachytherapy (ICBT) in patients with in-stent restenosis (ISR). However, it is unknown whether there might be differences between DES and ICBT in terms of efficacy and safety in large sample size and long-term follow-up.
  
  
  OBJECTIVE
  The aim of this study was to determine whether DES implantation remains favorable in large sample size and long-term follow-up when compared with ICBT among patients with ISR.
  
  
  METHODS
  We conducted a search in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials without language restrictions. A meta-analysis of 1942 cases from 12 controlled trials of DES vs ICBT for ISR was performed.
  
  
  RESULTS
  Drug-eluting stents were significantly more effective in reducing target-vessel revascularization (TVR) (odds ratio [OR]: 0.44, 95% confidence interval [CI]: 0.23-0.81, P = 0.009) and binary restenosis (OR: 0.34, 95% CI: 0.26-0.46, P<0.00001) compared with ICBT at midterm follow-up. There were no significant differences between DES and ICBT in cardiac death, myocardial infarction (MI), and late stent thrombosis at midterm follow-up. A statistical significance has been found between the 2 groups in TVR (OR: 0.61, 95% CI: 0.43-0.86, P = 0.005) at long-term follow-up. There were no significant differences in cardiac death and MI between the 2 groups at long-term follow-up.
  
  
  CONCLUSIONS
  These findings provide evidence that DES is superior to ICBT for the treatment of ISR in TVR and binary restenosis reduction, but not in cardiac death, MI, and late stent thrombosis reduction. © 2011 Wiley Periodicals, Inc. Yong-Guang Lu, MD, and Yan-Mei Chen, MD, contributed equally to this work. The authors have no funding, financial relationships, or conflicts of interest to disclose.
authors.affiliation: Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
authors.forename: Yong-Guang
authors.initials: YG
authors.lastname: Lu
authors.forename: Yan-Mei
authors.initials: YM
authors.lastname: Chen
authors.forename: Lang
authors.initials: L
authors.lastname: Li
authors.forename: Rong-Zhen
authors.initials: RZ
authors.lastname: Zhao
authors.forename: Chun-Hui
authors.initials: CH
authors.lastname: Fu
authors.forename: Hua
authors.initials: H
authors.lastname: Yan
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D001918:Brachytherapy / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D023903:Coronary Restenosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D023921:Coronary Stenosis / Q000401:mortality / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D016017:Odds Ratio; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome