Key result
DES linked to ~37% lower risk of major events vs BMS for bare-metal ISR.
Why the study?
Do drug-eluting stents reduce the composite of death, MI, or target lesion revascularization compared to bare-metal stents in patients with bare-metal in-stent restenosis?
Cohort (n=706)
No
Do drug-eluting stents reduce the composite of death, MI, or target lesion revascularization compared to bare-metal stents in patients with bare-metal in-stent restenosis?
Hazard Ratio: 0.63 (95% CI 0.42–0.95)
Absolute Event Rate: 21% vs 45%
p-value: p=0.03
In patients with bare-metal in-stent restenosis, treatment with drug-eluting stents significantly reduced the long-term composite risk of death, MI, or target lesion revascularization compared to bare-metal stents.
May support DES preference in bare-metal ISR; leaves open need for RCT confirmation before practice change.
OBJECTIVES: We compared the long-term outcomes of drug-eluting stents (DES) versus bare-metal stents (BMS) for treatment of bare-metal in-stent restenosis (ISR). BACKGROUND: There are no randomized trials or observational studies directly comparing the safety and efficacy of DES versus BMS for treatment of bare-metal ISR. METHODS: We examined data on all patients who underwent percutaneous coronary intervention (PCI) for ISR at Cleveland Clinic between 05/1999 and 06/2007. We compared the efficacy and safety of DES to BMS for treating bare-metal ISR. The primary end point was a composite of death, myocardial infarction (MI), or target lesion revascularization (TLR). The secondary endpoints were individual components of the primary endpoint. RESULTS: Of the 931 patients identified over 8 years, 706 had bare-metal ISR and met our study criteria. Of the 706 patients with bare-metal ISR, 362 were treated with DES and 344 with BMS. There were 230 cumulative events for a median follow-up of 3.2 years. After adjusting for 27 variables, DES were associated with lower primary endpoint compared to BMS for treatment of bare-metal ISR (21% vs. 45%, adjusted hazard ratio [HR] 0.63; 95% confidence interval [CI], 0.42-0.95; P = 0.03). The individual secondary endpoint of death (8% vs. 24%, P = 0.005) favored DES, but MI (3% vs. 8%, P = 0.31), and TLR (13% vs. 20%, P = 0.23) failed to reach statistical significance. CONCLUSIONS: In our multivariate analysis of patients with bare-metal ISR, DES use was associated with significantly lower death, MI, or TLR when compared to BMS.
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Singh et al. (2010) conducted a cohort in bare-metal in-stent restenosis (n=706). Drug-eluting stents vs. Bare-metal stents was evaluated on composite of death, myocardial infarction (MI), or target lesion revascularization (TLR) (HR 0.63, 95% CI 0.42-0.95, p=0.03). Drug-eluting stents were associated with a lower risk of death, MI, or target lesion revascularization compared to bare-metal stents for bare-metal ISR (HR 0.63; 95% CI 0.42-0.95; P=0.03).
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