title: Vascular brachytherapy versus drug-eluting stents in the treatment of in-stent restenosis: A meta-analysis of long-term outcomes.
abstract: BACKGROUND
  Clinical trials have shown a short-term benefit of drug-eluting stents (DES) compared to vascular brachytherapy (VBT) for treatment of in-stent restenosis (ISR). The long-term benefits of DES vs. VBT are conflicting in the literature. This study aimed to do a meta-analysis of long-term outcomes of DES compared to VBT for treatment of ISR.
  
  
  METHODS
  PubMed, EMBASE, Cochrane Central and unpublished data were searched for cohort studies and randomized controlled trials (RCTs) that directly compared VBT to DES for the treatment of ISR. We evaluated the following outcomes at 2-5 years of follow-up: target lesion revascularization (TLR), target vessel revascularization (TVR), myocardial infarction (MI), stent thrombosis, cardiovascular (CV) mortality, and overall mortality. Heterogeneity was defined as I(2) values > 25%. Review Manager 5.1 was used for statistical analysis.
  
  
  RESULTS
  We included 1,375 patients from five studies, of which three were RCTs. VBT was used to treat ISR in 685 (49.8%) patients. After a 2-5 year follow-up, no significant differences were found between treatment groups regarding MI (P = 0.49), stent thrombosis (P = 0.86), CV mortality (P = 0.35), and overall mortality (P = 0.71). TLR (OR 2.37; CI 1.55-3.63; P < 0.001) and TVR (OR 2.23; CI 1.01-4.94; P = 0.05) were significantly increased in patients who received VBT.
  
  
  CONCLUSIONS
  This study suggests that DES are associated with decreased long-term revascularization procedures when compared to VBT for the treatment of ISR. This benefit does not appear to be associated with a significant reduction in mortality or myocardial infarction.
authors.affiliation: Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Benjo
authors.affiliation: Department of Medicine, University of Miami, Miami, Florida.
authors.forename: Rhanderson N
authors.initials: RN
authors.lastname: Cardoso
authors.affiliation: Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana.
authors.forename: Tyrone
authors.initials: T
authors.lastname: Collins
authors.affiliation: Department of Medicine, University of Miami, Miami, Florida.
authors.forename: Daniel
authors.initials: D
authors.lastname: Garcia
authors.affiliation: Department of Cardiology, Baylor College of Medicine, Houston, Texas.
authors.forename: Francisco Y
authors.initials: FY
authors.lastname: Macedo
authors.affiliation: Department of Medicine, St. Luke's Roosevelt Hospital Center, New York, New York.
authors.forename: Georges
authors.initials: G
authors.lastname: El-Hayek
authors.affiliation: Department of Nephrology, Ichan Mount Sinai School of Medicine, New York, New York.
authors.forename: Girish
authors.initials: G
authors.lastname: Nadkarni
authors.affiliation: Department of Medicine, St. Luke's Roosevelt Hospital Center, New York, New York.
authors.forename: Emad
authors.initials: E
authors.lastname: Aziz
authors.affiliation: Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana.
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Jenkins
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D011474:Prosthesis Design; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
keywords: drug-eluting stent; in-stent restenosis; mortality; myocardial infarction; stent thrombosis; vascular brachytherapy