title: Implantation of a drug-eluting stent with a different drug (switch strategy) in patients with drug-eluting stent restenosis. Results from a prospective multicenter study (RIBS III [Restenosis Intra-Stent: Balloon Angioplasty Versus Drug-Eluting Stent]).
abstract: OBJECTIVE
  This study sought to assess the effectiveness of a strategy of using drug-eluting stents (DES) with a different drug (switch) in patients with DES in-stent restenosis (ISR).
  
  
  BACKGROUND
  Treatment of patients with DES ISR remains a challenge.
  
  
  METHODS
  The RIBS-III (Restenosis Intra-Stent: Balloon Angioplasty Versus Drug-Eluting Stent) study was a prospective, multicenter study that aimed to assess results of coronary interventions in patients with DES ISR. The use of a different DES was the recommended strategy. The main angiographic endpoint was minimal lumen diameter at 9-month follow-up. The main clinical outcome measure was a composite of cardiac death, myocardial infarction, and target lesion revascularization.
  
  
  RESULTS
  This study included 363 consecutive patients with DES ISR from 12 Spanish sites. The different-DES strategy was used in 274 patients (75%) and alternative therapeutic modalities (no switch) in 89 patients (25%). Baseline characteristics were similar in the 2 groups, although lesion length was longer in the switch group. At late angiographic follow-up (77% of eligible patients, median: 278 days) minimal lumen diameter was larger (1.86 ± 0.7 mm vs. 1.40 ± 0.8 mm, p = 0.003) and recurrent restenosis rate lower (22% vs. 40%, p = 0.008) in the different-DES group. At the last clinical follow-up (99% of patients, median: 771 days), the combined clinical endpoint occurred less frequently (23% vs. 35%, p = 0.039) in the different-DES group. After adjustment using propensity score analyses, restenosis rate (relative risk: 0.41, 95% confidence interval [CI]: 0.21 to 0.80, p = 0.01), minimal lumen diameter (difference: 0.41 mm, 95% CI: 0.19 to 0.62, p = 0.001), and the event-free survival (hazard ratio: 0.56, 95% CI: 0.33 to 0.96, p = 0.038) remained significantly improved in the switch group.
  
  
  CONCLUSIONS
  In patients with DES ISR, the implantation of a different DES provides superior late clinical and angiographic results than do alternative interventional modalities.
authors: Clinico San Carlos University Hospital, Plaza de Cristo Rey, Madrid, Spain. falf@hotmail.com
authors: Fernando
authors: F
authors: Alfonso
authors: Maria J
authors: MJ
authors: Pérez-Vizcayno
authors: Jaime
authors: J
authors: Dutary
authors: Javier
authors: J
authors: Zueco
authors: Angel
authors: A
authors: Cequier
authors: Arturo
authors: A
authors: García-Touchard
authors: Vicens
authors: V
authors: Martí
authors: Iñigo
authors: I
authors: Lozano
authors: Juan
authors: J
authors: Angel
authors: José M
authors: JM
authors: Hernández
authors: José R
authors: JR
authors: López-Mínguez
authors: Rafael
authors: R
authors: Melgares
authors: Raúl
authors: R
authors: Moreno
authors: Bernhard
authors: B
authors: Seidelberger
authors: Cristina
authors: C
authors: Fernández
authors: Rosana
authors: R
authors: Hernandez
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D003331:Coronary Vessels / Q000473:pathology; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D012306:Risk; D013030:Spain