title: Efficacy of drug-eluting stents for treating in-stent restenosis of drug-eluting stents (from the Korean DES ISR multicenter registry study [KISS]).
abstract: There is currently no established standard treatment for in-stent restenosis (ISR) after the implantation of a drug-eluting stent (DES). The aim of this study was to investigate the efficacy of DES versus balloon angioplasty (BA) for the treatment of DES ISR in a multicenter registry cohort. After matching propensity scores of 805 patients with DES ISR treated with either DES (n = 422) or BA (n = 383), 268 matched pairs were selected and analyzed for major adverse cardiac events, a composite of death, myocardial infarction, and target-vessel revascularization, as the primary end point. Baseline clinical and lesion characteristics of the matched pairs were similar. Survival free of major adverse cardiac events at 2 years was higher with DES compared to BA (88.9% vs 78.7%, p <0.001), mainly because of higher TVR-free survival (92.4% vs 81.0%, p <0.001). Among various baseline variables, BA (hazard ratio 2.546, 95% confidence interval 1.412 to 4.593, p = 0.002) was the most important independent risk factor for recurrent target vessel revascularization, followed by acute coronary syndromes as the clinical presentation of DES ISR, and previous implantation of a sirolimus-eluting stent. Survival free of death, myocardial infarction, or stent thrombosis did not differ between the 2 groups. Whereas there was no significant difference in survival free of target vessel revascularization between DES and BA for focal ISR lesions, DES was superior to BA in diffuse ISR lesions (94.3% vs 75.2% at 2 years, p <0.001). In conclusion, compared to BA, the implantation of DES was safe and more effective in the treatment of DES ISR.
authors.affiliation: Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.
authors.forename: Young-Guk
authors.initials: YG
authors.lastname: Ko
authors.forename: Jung-Sun
authors.initials: JS
authors.lastname: Kim
authors.forename: Byeong-Keuk
authors.initials: BK
authors.lastname: Kim
authors.forename: Donghoon
authors.initials: D
authors.lastname: Choi
authors.forename: Myeong-Ki
authors.initials: MK
authors.lastname: Hong
authors.forename: Dong Woon
authors.initials: DW
authors.lastname: Jeon
authors.forename: Joo-Young
authors.initials: JY
authors.lastname: Yang
authors.forename: Young Keun
authors.initials: YK
authors.lastname: Ahn
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Cheol Woong
authors.initials: CW
authors.lastname: Yu
authors.forename: Kyeong-Ho
authors.initials: KH
authors.lastname: Yun
authors.forename: Do-Sun
authors.initials: DS
authors.lastname: Lim
authors.forename: Yangsoo
authors.initials: Y
authors.lastname: Jang
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D002423:Cause of Death / Q000639:trends; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D054855:Drug-Eluting Stents; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D011379:Prognosis; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D017211:Treatment Failure; D016896:Treatment Outcome