Key result
Drug-eluting balloons show no significant MACE benefit over angioplasty or DES for in-stent restenosis.
Why the study?
Treatment of coronary in-stent restenosis is still associated with a high incidence of recurrence, and the comparative efficacy and safety of drug-eluting balloons versus conventional balloon angioplasty and drug-eluting stents is unclear.
Cohort (n=177)
No
Absolute Event Rate: 10.7% vs 15.4%
p-value: p=>0.05
DEB appears comparable for ISR; should not yet change practice without randomized confirmation.
BACKGROUND/AIMS: Treatment of coronary in-stent restenosis (ISR) is still associated with a high incidence of recurrence. We aimed to compare the efficacy and safety of drug-eluting balloons (DEB) for the treatment of ISR as compared with conventional balloon angioplasty (BA) and drug-eluting stents (DES). METHODS: Between January 2006 and May 2012 a total of 177 patients (188 lesions, 64.1 ± 11.7 years old) who underwent percutaneous coronary intervention for ISR were retrospectively enrolled. Clinical outcomes were compared between patients treated with DEB (n = 58, 32.8%), conventional BA (n = 65, 36.7%), or DES (n = 54, 30.5%). The primary end point was a major adverse cardiac event (MACE), defined as a composite of cardiac death, myocardial infarction, and target lesion revascularization(TLR). RESULTS: Baseline characteristics were not different except for a history of previous MI, which was more frequent in patients treated by conventional BA or DES than in patients treated by DEB (40.0% vs. 48.1% vs. 17.2%, respectively, p = 0.002). The total incidences of MACEs were 10.7%, 7.4%, and 15.4% in patients treated by DEB, DES, or conventional BA, respectively (p > 0.05). TLR was more frequent in patients treated by conventional BA than in patients treated by DEB or DES, but this was not statistically significant (10.8% vs. 6.9% vs. 3.7%, p > 0.05 between all group pairs, respectively). CONCLUSIONS: This study showed that percutaneous coronary intervention using DEB might be a feasible alternative to conventional BA or DES implantation for treatment of coronary ISR. Further large-scaled, randomized study assessing long-term clinical and angiographic outcomes will be needed.
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Oh et al. (2015) conducted a cohort in Coronary in-stent restenosis (ISR) (n=177). Drug-eluting balloon vs. Conventional balloon angioplasty or drug-eluting stents was evaluated on Major adverse cardiac event (MACE), defined as a composite of cardiac death, myocardial infarction, and target lesion revascularization (TLR) (p=>0.05). Drug-eluting balloons for the treatment of coronary in-stent restenosis resulted in a major adverse cardiac event rate of 10.7%, which was not significantly different compared to conventional balloon angioplasty (15.4%) or drug-eluting stents (7.4%).
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