Key result
Thin-strut DES shows no benefit over paclitaxel-DCB for TLR in ACS patients with restenosis.
Why the study?
The long-term outcomes of patients with drug-eluting stent in-stent restenosis presenting with ACS and undergoing PCI with either drug-coated balloons or thin-strut DES are not well studied.
Does PCI with thin-strut DES reduce target lesion revascularization compared to paclitaxel drug-coated balloon in patients with drug-eluting stent in-stent restenosis presenting with acute coronary syndrome?
Observational (n=1,317)
Does PCI with thin-strut DES reduce target lesion revascularization compared to paclitaxel drug-coated balloon in patients with drug-eluting stent in-stent restenosis presenting with acute coronary syndrome?
In patients with ACS undergoing PCI for DES in-stent restenosis, thin-strut DES and paclitaxel drug-coated balloons yielded statistically comparable rates of target lesion revascularization and device-oriented composite endpoints.
Comparable TLR rates with thin-DES versus DCB after matching; leaves open optimal strategy pending randomized trials in ACS with DES-ISR.
Background The long-term outcomes of patients with in-stent restenosis (ISR) presenting with Acute Coronary Syndrome (ACS) are not well studied. This study aims at investigating the outcomes of patients with drug-eluting stents (DES)-ISR presenting with ACS undergoing percutaneous coronary intervention (PCI) with DCB or thin strut-DES. Methods Consecutive patients from the Dragon-Register with DES-ISR who underwent PCI with thin-DES or paclitaxel-DCB were enrolled [Figure 1]. Primary outcome was target lesion revascularization (TLR). Secondary outcomes were 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 (44.4%) were treated with a thin-DES and 732 (55,6%) with drug-coated balloons. In the crude analysis of patients with ACS (N = 697) undergoing PCI for ISR, thin-DES vs. DCB showed similar outcomes for TLR (HR = 1.21, 95% CI 0.78–1.86; P = 0.400), TVR (HR = 0.91, 95% CI 0.62–1.34; P = 0.641), MI (HR = 1.25, 95% CI 0.82–1.86; P = 0.281), TV-MI (HR = 0.91, 95% CI 0.43–1.90; P = 0.793), CV death (HR = 0.76, 95% CI 0.27–2.09; P = 0.589), and DOCE (HR = 1.04, 95% CI 0.70–1.54; P = 0.840). After propensity score matching (N = 606), the HRs remained non-significant for TLR (1.08, 95% CI 0.69–1.69; P = 0.731 [Figure 2]), TVR (0.88, 95% CI 0.59–1.31; P = 0.523), MI (1.24, 95% CI 0.80–1.91; P = 0.336), TV-MI (0.93, 95% CI 0.43–2.05; P = 0.865), CV death (0.75, 95% CI 0.26–2.18; P = 0.602), and DOCE (0.98, 95% CI 0.65–1.46; P = 0.904). Conclusions In patients with acute coronary syndrome undergoing percutaneous coronary intervention for in-stent restenosis, treatment with thin-DES was associated with a numerical reduction in the rates of TLR and DOCE compared with DCB. However, these differences did not achieve statistical significance in either the crude or propensity score–matched analyses.
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Januszek et al. (2026) conducted an observational in In-stent restenosis in acute coronary syndrome (n=1,317). Thin-strut drug-eluting stent (thin-DES) vs. Paclitaxel drug-coated balloon (DCB) was evaluated on Target lesion revascularization (TLR) (HR 1.08, 95% CI 0.69-1.69, p=0.731). Thin-strut DES vs. paclitaxel-DCB in ACS patients with DES in-stent restenosis showed no significant difference in target lesion revascularization (matched HR 1.08, 95% CI 0.69-1.69; P=0.731).
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