title: Drug-eluting balloons versus drug-eluting stents for the management of in-stent restenosis: A meta-analysis of randomized and observational studies.
abstract: OBJECTIVE
  The aim of this study was to evaluate the efficacy of drug-eluting balloons (DEB) with drug-eluting stents (DES) in patients with in-stent restenosis (ISR).
  
  
  BACKGROUND
  DES implantation and DEB were available strategies in percutaneous coronary intervention (PCI) for ISR, but the optimal management for ISR lesions remains controversial.
  
  
  METHODS
  Electronic databases were searched for randomized controlled trials and observational cohort studies which reported the clinical outcomes of using DEB comparing with DES implantation in patients with ISR. Clinical endpoints such as major adverse cardiovascular events (MACE), death, and myocardial infarction were assessed.
  
  
  RESULTS
  Five randomized controlled trials and five observational cohort studies with 962 patients in the DEB group and 908 patients in the DES group met inclusion criteria. There was no significant difference between DEB and DES in major clinical outcomes, such as MACE (OR 1.01; 95% CI: 0.64-1.58; p=0.97; I2=0%), all-cause death (OR 1.04; 95% CI: 0.54-1.98; p=0.91; I2=0%), cardiovascular death (OR 1.44; 95% CI: 0.57-3.65; p=0.44; I2=0%), stent thrombosis (OR 0.61; 95% CI: 0.16-2.33; p=0.47; I2=0%), and myocardial infarction (OR 1.02; 95% CI: 0.53-1.94; p=0.96; I2=0%). DEB was associated with a significant increase in target lesion revascularization (OR 1.54; 95% CI: 1.10-2.15; p=0.01; I2=57%).
  
  
  CONCLUSIONS
  Treatment of ISR using DEB led to comparable clinical outcomes with DES implantation.
authors.affiliation: Department of Cardiology, Ningbo Medical Treatment Center Lihuili Hospital, Ningbo, PR China.
authors.forename: Yanwei
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Emergency, Dongyang Hospital of Traditional Chinese Medicine, Jinhua, PR China.
authors.forename: Xinmin
authors.initials: X
authors.lastname: Lou
authors.affiliation: Department of Endocrinology, People Hospital of Tiantai, Taizhou, PR China.
authors.forename: Xiaomin
authors.initials: X
authors.lastname: Xu
authors.affiliation: Department of Cardiology, The First Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, PR China.
authors.forename: Jianhua
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Department of Cardiology, The First Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, PR China. Electronic address: shangypzj@163.com.
authors.forename: Yunpeng
authors.initials: Y
authors.lastname: Shang
mesh_terms: D023903:Coronary Restenosis / Q000628:therapy*; D016503:Drug Delivery Systems / Q000009:adverse effects; D054855:Drug-Eluting Stents / Q000009:adverse effects; D006801:Humans; D064887:Observational Studies as Topic; D062645:Percutaneous Coronary Intervention; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
keywords: Drug-eluting balloons; Drug-eluting stents; In-stent restenosis