title: Retrospective Study of First-Generation Drug-Eluting Stents, Second-Generation Drug-Eluting Stents and Non-Drug Eluting Stent Methods in the Treatment of Native Vessel In-Stent Restenosis in Real-World Clinical Practice.
abstract: BACKGROUND
  The efficacy of second-generation drug-eluting stents (DES) in treating in-stent restenosis (ISR) compared to first-generation DES and non-DES treatment methods in real-world cohorts has not yet been adequately addressed. This research intends to examine optimum treatment of in-stent restenosis, considering first-generation DES, second-generation DES and non-DES treatment methods in a real-world cohort.
  
  
  METHODS
  Retrospective analysis was performed on 114 patients treated for native-vessel BMS or DES ISR. Thirty-two were treated with a first-generation DES (81% sirolimus, 19% paclitaxel), 32 with a second-generation DES (72% everolimus, 28% zotarolimus) and 28 with non-DES methods (32% bare-metal stent, 39% balloon angioplasty, 29% cutting balloon). The composite primary endpoint was total adverse cardiac events, recurrent stable angina, unstable angina, myocardial infarction (MI), target vessel revascularisation (TVR) and cardiac death at minimum clinical follow-up of six months.
  
  
  RESULTS
  Primary endpoint rates were significantly higher in the non-DES and second-generation DES treatment groups than in first-generation DES (42.9%, 25.9%, 6.2%; p=0.004). Rates of MI and TVR were significantly higher in the non-DES treatment group, compared to first and second-generation DES (MI: 17.9%, 0%, 5.6%; p=0.018; TLR: 21.4%, 3.1%, 7.4%; p=0.041).
  
  
  CONCLUSIONS
  First-generation DES may be superior to second-generation DES and non-DES in treating BMS or DES ISR with regard to overall adverse cardiac events.
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Queensland, Australia. Electronic address: drew.j.yates@gmail.com.
authors.forename: Drew J
authors.initials: DJ
authors.lastname: Yates
authors.affiliation: Cardiology Program, The Prince Charles Hospital, Brisbane, Queensland, Australia.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Savage
authors.affiliation: The Prince Charles Hospital, Chermside, Queensland, Australia.
authors.forename: Darren L
authors.initials: DL
authors.lastname: Walters
authors.affiliation: The Prince Charles Hospital, Chermside, Queensland, Australia.
authors.forename: Owen C
authors.initials: OC
authors.lastname: Raffel
mesh_terms: D000368:Aged; D060050:Angina, Stable / Q000209:etiology*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D000068338:Everolimus / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology*; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D000068338:Everolimus; C489443:zotarolimus; D020123:Sirolimus
keywords: Everolimus; In-stent restenosis; Paclitaxel; Percutaneous coronary intervention; Sirolimus; Zotarolimus