Key result
DES or DEB cuts target lesion revascularization by ~50% vs balloon angioplasty for in-stent restenosis.
Why the study?
The optimal management for coronary drug eluting stent in-stent restenosis (DES ISR) is unclear.
Meta-Analysis (n=7,474)
Odds Ratio: 0.5 (95% CI 0.36–0.69)
Supports DES or DEB over balloon angioplasty for DES in-stent restenosis; confirms lower TLR in Level 1 evidence.
BACKGROUND: The optimal management for coronary drug eluting stent in-stent restenosis (DES ISR) is unclear. We performed a meta-analysis of observational and randomized studies to compare the outcomes of management of DES ISR using DES, drug eluting balloon (DEB), or balloon angioplasty (BA). METHODS: Eligible studies (25 single arm and 13 comparative, including 4 randomized studies with a total of 7,474 patients with DES ISR) were identified using MEDLINE search and proceedings of international meetings. Outcomes studied include major adverse cardiac events (MACE), target lesion revascularization (TLR), target vessel revascularization (TVR), myocardial infarction (MI), stent thrombosis (ST), and mortality. Follow-up ranged from 0.5 to 3.5 years (mean 1.4 years). RESULTS: The rate of TLR was significantly lower in the DES (odds ratio [OR] 0.50, 95% confidence interval [CI] 0.36-0.69) and DEB (OR 0.31, 95% CI 0.18-0.55) groups compared to BA. Similarly, TVR rate was significantly lower in the DES (OR 0.55, 95% CI 0.39-0.77) and DEB (OR 0.32, 95% CI 0.18-0.58) groups compared to BA. All other outcomes were similar between the DES/BA and DEB/BA comparisons. TLR was significantly lower in the DES group compared to BA for vessels < or > 2.75 mm. CONCLUSION: Treatment of coronary DES ISR with DES or DEB is associated with a reduction in the risk of TLR and TVR compared to BA alone. The relative risk reduction for TLR with DES is similar to DEB. DEBs have a potential role in the treatment of DES ISR by avoiding placement of another layer of stent.
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Goel et al. (2015) conducted a meta-analysis in coronary drug eluting stent in-stent restenosis (n=7,474). Drug eluting stent (DES) or drug eluting balloon (DEB) vs. Balloon angioplasty (BA) was evaluated on Target lesion revascularization (TLR) for DES vs BA (OR 0.50, 95% CI 0.36-0.69). Treatment of coronary DES in-stent restenosis with DES (OR 0.50; 95% CI 0.36-0.69) or DEB (OR 0.31; 95% CI 0.18-0.55) reduced target lesion revascularization compared to balloon angioplasty.
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