Comparison between drug-coated balloon angioplasty and second-generation drug-eluting stent placement for the treatment of in-stent restenosis after drug-eluting stent implantation.
Even though drug-coated balloon (DCB) angioplasty has emerged as a treatment option for drug-eluting stent in-stent restenosis (DES-ISR), the most effective treatment strategy for DES-ISR is still under debate. Therefore, we compared long-term clinical outcomes following DCB treatment of DES-ISR with those following 2nd-generation drug-eluting stent (DES) treatment. We identified 248 DES-ISR lesions in 238 patients that were treated with either 2nd-generation DES implantation (n = 56) or DCB angioplasty (n = 192). We compared the incidences of major adverse cardiac events (MACEs) in the two groups during the 2-year period following treatment. MACE was defined as cardiac death, non-fatal myocardial infarction, or target-vessel revascularization. The percentage of patients with diabetes and the mean age of patients in the DCB group were greater than in the DES group. The DCB group also had a smaller reference vessel diameter. The DES group had a larger post-intervention minimal luminal diameter. We found no significant difference in the MACE rate between the two groups during the 2 years following treatment (11.0 % in the DCB group vs. 8.9 % in the DES group, p = 0.660). Reference segment diameter was the only independent predictive factor for MACE in the post-treatment period (hazard ratio 0.35, 95 % confidence interval: 0.15-0.82, p = 0.016). Clinical efficacy of DCB angioplasty for treatment of DES-ISR was comparable to that of 2nd-generation DES implantation as measured by the rate of MACEs in the two groups. Reference segment diameter was the only statistically significant independent predictor for MACE in the 2-year period following treatment.
Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
In Sook
IS
Kang
Department of Cardiology, Zagazig University, Zagazig, Egypt.
Islam
I
Shehata
Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.|Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 134 Sinchon-dong, Seodaemun-gu, Seoul, 120-752, Korea.
Dong-Ho
DH
Shin
Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.|Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 134 Sinchon-dong, Seodaemun-gu, Seoul, 120-752, Korea.
Jung-Sun
JS
Kim
Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.|Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 134 Sinchon-dong, Seodaemun-gu, Seoul, 120-752, Korea.
Byeong-Keuk
BK
Kim
Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.|Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 134 Sinchon-dong, Seodaemun-gu, Seoul, 120-752, Korea.
Young-Guk
YG
Ko
Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.|Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 134 Sinchon-dong, Seodaemun-gu, Seoul, 120-752, Korea.
Donghoon
D
Choi
Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.|Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 134 Sinchon-dong, Seodaemun-gu, Seoul, 120-752, Korea.|Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Yangsoo
Y
Jang
Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea. mkhong61@yuhs.ac.|Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 134 Sinchon-dong, Seodaemun-gu, Seoul, 120-752, Korea. mkhong61@yuhs.ac.|Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea. mkhong61@yuhs.ac.
Myeong-Ki
MK
Hong
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D062906:Cardiac Catheters; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D020099:Coated Materials, Biocompatible; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D002317:Cardiovascular Agents; D020099:Coated Materials, Biocompatible
Angioplasty; Coronary artery disease; Restenosis; Stent