Thin-strut DES showed a non-significant numerical reduction in TLR, TVR, and DOCE compared to drug-coated balloons in CKD patients with DES-ISR (e.g., TLR HR 0.52, P=0.159).
Does thin-strut drug-eluting stent reduce target lesion revascularization compared to paclitaxel drug-coated balloon in patients with chronic kidney disease and drug-eluting stent in-stent restenosis?
In patients with chronic kidney disease and DES in-stent restenosis, treatment with thin-strut DES compared to paclitaxel-DCB resulted in numerically lower but statistically non-significant rates of target lesion revascularization.
Absolute Event Rate: 0% vs 0%
Abstract Background The long-term outcomes of patients with in-stent restenosis (ISR) presenting with chronic kidney disease (CKD) are not well studied. This study aims at investigating the outcomes of patients with drug-eluting stents (DES)-ISR presenting with CKD undergoing percutaneous coronary intervention (PCI) with drug-coated balloon (DCB) or thin strut drug-eluting stent (DES). Methods Consecutive patients with DES-ISR who underwent PCI with thin-DES or paclitaxel-DCB for DES-ISR were enrolled. Primary outcome was target lesion revascularization (TLR), while secondary: target vessel revascularization (TVR) and device-oriented composite endpoint DOCE, cardiac death, TLR, and target vessel myocardial infarction (TV-MI). Propensity-score matching was used to adjust for baseline differences. Results A total of 1,317 patients were included in the pooled analysis of whom 585 (44.42%) were treated with a thin-DES and 732 (55, 58%) with drug-coated balloons. In the crude analysis of patients with CKD (N=286) undergoing PCI for ISR, thin-DES vs. DCB showed similar outcomes for TLR (HR=0.94, 95% CI 0.44–2.00; P=0.873), TVR (HR=0.82, 0.44–1.55; P=0.542), MI (HR=0.71, 0.34–1.46; P=0 .348), TV-MI (HR=0.67, 0.19–2.31; P=0.527), CV death (HR=0.88, 0.22–3.55; P=0.855), and DOCE (HR=0.71, 0.36–1.40; P=0.325). After propensity score matching (N=184), the HRs remained non-significant for TLR (0.52, 0.21–1.29; P = 0.159), TVR (0.54, 0.24–1.01; P=0.134), MI (0.56, 0.24 – 1.32; P=0.183), TV-MI (0.56, 0.09 – 3.39; P = 0.528), CV death (0.63, 0.10–3.81; P=0.615), and DOCE (0.45, 0.19–1.04; P=0.062 Fig.). Conclusions In patients with chronic kidney disease undergoing percutaneous coronary intervention for in-stent restenosis, treatment with thin-DES was associated with a numerical reduction in the rates of TLR, TVR, and DOCE compared with DCB. However, these differences did not achieve statistical significance in either the crude or propensity score–matched analyses.
Januszek et al. (Sat,) reported a other. Thin-strut DES showed a non-significant numerical reduction in TLR, TVR, and DOCE compared to drug-coated balloons in CKD patients with DES-ISR (e.g., TLR HR 0.52, P=0.159).