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Comparative Efficacy and Safety of Drug-Eluting Stent and Conventional Therapies in Coronary Heart Disease Patients with In-Stent Restenosis: A Meta-Analysis

  • Translational Biomedical Research
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Abstract

We performed a meta-analysis to compare therapeutic outcome/safety of drug-eluting stent (DES) and conventional in-stent restenosis (ISR) treatments. We browsed through large volume of clinical data by searching MEDLINE, EMBASE, Cochrane central register of controlled trials, and EBSCO databases. In this study, 11 randomized controlled trials, 17 non-randomized controlled trials, 6,330 patients, and 6,662 lesions were included. Clinical and coronary angiography follow-up for 6–16 months was included. The major outcomes were target lesion revascularization (TLR) and major adverse cardiac events (MACE). We found that DES showed advantage in TLR (OR = 0.46; 95 % CI: 0.34, 0.62; P < 0.00001), MACE (OR = 0.51; 95 % CI: 0.34, 0.77; P = 0.001), Late Lumen Loss (IV = −0.30; 95 % CI: −0.44, −0.15; P < 0.0001), stenosis of lumen diameter (OR = −17.45; 95 % CI: −23.69, −11.21; P < 0.00001), and restenosis (OR = 0.26; 95 % CI: 0.17, 0.40; P < 0.00001) over conventional ISR treatment. Regarding cardiac death (OR = 0.80; 95 % CI: 0.55, 1.17; P = 0.25), myocardial infarction (OR = 1.00;95 %CI: 0.66, 1.51; P = 1.00) and late thrombosis (OR = 0.70; 95 % CI: 0.42, 1.17; P = 0.18), there was no significant difference between different treatments. We, therefore, concluded that in treating percutaneous coronary intervention–ISR, DES was more effective in reducing incidence of TLR, MACE, and restenosis, and decreasing severity of late lumen loss/stenosis of lumen diameter compared with bare metal stent, percutaneous transluminal coronary angioplasty, intracoronary brachytherapy, and cutting balloon treatments. There was no significant difference between DES and conventional therapy for ISR. As suggested by current statistical analysis, DES after ISR did not involve a higher incidence of cardiac death, myocardial infarction, and thrombosis.

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References

  1. Liistro, F., Fineschi, M., Angioli, P., et al. (2006). Effectiveness and safety of sirolimus stent implantation for coronary in-stent restenosis: The TRUE (Tuscany registry of sirolimus for unselected in-stent restenosis) registry. Journal of the American College of Cardiology, 48, 270–275.

    Article  CAS  PubMed  Google Scholar 

  2. Aminian, A., Kabir, T., & Eeckhout, E. (2009). Treatment of drug-eluting stent restenosis: An emerging challenge. Catheterization and Cardiovascular Interventions, 74, 108–116.

    Article  PubMed  Google Scholar 

  3. Wijns, W., Kolh, P., Danchin, N., et al. (2010). Guidelines on myocardial revascularization. European Heart Journal, 31, 2501–2555.

    Article  PubMed  Google Scholar 

  4. Neumann, F. J., Desmet, W., Grube, E., et al. (2005). Effectiveness and safety of sirolimus-eluting stents in the treatment of restenosis after coronary stent placement. Circulation, 111, 2107–2111.

    Article  CAS  PubMed  Google Scholar 

  5. Kastrati, A., Mehilli, J., von Beckerath, N., et al. (2005). Sirolimus-eluting stent or paclitaxel-eluting stent vs balloon angioplasty for prevention of recurrences in patients with coronary in-stent restenosis: A randomized controlled trial. JAMA, 293, 165–171.

    Article  CAS  PubMed  Google Scholar 

  6. Holmes, D. R, Jr, Teirstein, P., Satler, L., et al. (2006). Sirolimus-eluting stents vs vascular brachytherapy for in-stent restenosis within bare-metal stents: The SISR randomized trial. JAMA, 295, 1264–1273.

    Article  CAS  PubMed  Google Scholar 

  7. Stone, G. W., Ellis, S. G., O’Shaughnessy, C. D., et al. (2006). Paclitaxel-eluting stents vs vascular brachytherapy for in-stent restenosis within bare-metal stents: The TAXUS V ISR randomized trial. JAMA, 295, 1253–1263.

    Article  CAS  PubMed  Google Scholar 

  8. Alfonso, F., Perez-Vizcayno, M. J., Hernandez, R., et al. (2006). A randomized comparison of sirolimus-eluting stent with balloon angioplasty in patients with in-stent restenosis: Results of the restenosis intrastent: Balloon angioplasty versus elective sirolimus-eluting stenting (RIBS-II) trial. Journal of the American College of Cardiology, 47, 2152–2160.

    Article  CAS  PubMed  Google Scholar 

  9. Unverdorben, M., Vallbracht, C., Cremers, B., et al. (2009). Paclitaxel-coated balloon catheter versus paclitaxel-coated stent for the treatment of coronary in-stent restenosis. Circulation, 119, 2986–2994.

    Article  CAS  PubMed  Google Scholar 

  10. Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2010). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. International Journal of Surgery, 8, 336–341.

    Article  PubMed  Google Scholar 

  11. Ardissino, D., Cavallini, C., Bramucci, E., et al. (2004). Sirolimus-eluting vs uncoated stents for prevention of restenosis in small coronary arteries: A randomized trial. JAMA, 292, 2727–2734.

    Article  CAS  PubMed  Google Scholar 

  12. Schukro, C., Syeda, B., Kirisits, C., et al. (2007). Randomized comparison between intracoronary beta-radiation brachytherapy and implantation of paclitaxel-eluting stents for the treatment of diffuse in-stent restenosis. Radiotherapy and Oncology, 82, 18–23.

    Article  CAS  PubMed  Google Scholar 

  13. Alfonso, F., Perez-Vizcayno, M. J., Hernandez, R., et al. (2008). Sirolimus-eluting stents versus bare-metal stents in patients with in-stent restenosis: Results of a pooled analysis of two randomized studies. Catheterization and Cardiovascular Interventions, 72, 459–467.

    Article  PubMed  Google Scholar 

  14. Ellis, S. G., O’Shaughnessy, C. D., Martin, S. L., et al. (2008). Two-year clinical outcomes after paclitaxel-eluting stent or brachytherapy treatment for bare metal stent restenosis: the TAXUS V ISR trial. European Heart Journal, 29, 1625–1634.

    Article  PubMed  Google Scholar 

  15. Park, S. W., Lee, S. W., Koo, B. K., et al. (2008). Treatment of diffuse in-stent restenosis with drug-eluting stents vs. intracoronary beta-radiation therapy: INDEED study. International Journal of Cardiology, 131, 70–77.

    Article  PubMed  Google Scholar 

  16. Wiemer, M., Konig, A., Rieber, J., et al. (2011). Sirolimus-eluting stent implantation versus beta-irradiation for the treatment of in-stent restenotic lesions: Clinical and ultrasound results from a randomised trial. EuroIntervention, 6, 687–694.

    Article  PubMed  Google Scholar 

  17. Ko, Y. G., Kim, J. S., Kim, B. K., et al. (2012). Efficacy of drug-eluting stents for treating in-stent restenosis of drug-eluting stents (from the Korean DES ISR Multicenter Registry Study [KISS]). American Journal of Cardiology, 109, 607–613.

    Article  PubMed  Google Scholar 

  18. Tagliareni, F., La Manna, A., Saia, F., Marzocchi, A., & Tamburino, C. (2010). Long-term clinical follow-up of drug-eluting stent restenosis treatment: Retrospective analysis from two high volume catheterisation laboratories. EuroIntervention, 5, 703–708.

    Article  PubMed  Google Scholar 

  19. Abe, M., Kimura, T., Morimoto, T., et al. (2010). Sirolimus-eluting stent versus balloon angioplasty for sirolimus-eluting stent restenosis: Insights from the j-Cypher registry. Circulation, 122, 42–51.

    Article  CAS  PubMed  Google Scholar 

  20. Sardella, G., Colantonio, R., De Luca, L., et al. (2009). Comparison between balloon angioplasty and additional coronary stent implantation for the treatment of drug-eluting stent restenosis: 18-month clinical outcomes. Journal of Cardiovascular Medicine, 10, 469–473.

    Article  PubMed  Google Scholar 

  21. Liistro, F., Fineschi, M., Grotti, S., et al. (2009). Long-term clinical outcome of alternative treatment strategies for drug-eluting stents restenosis. EuroIntervention, 5, 454–459.

    Article  PubMed  Google Scholar 

  22. Zavalloni, D., Belli, G., Rossi, M. L., et al. (2006). Comparison between drug-eluting stents and beta-radiation for the treatment of diffuse in-stent restenosis: Clinical and angiographic outcomes. American Heart Journal, 152(908), e1–e7.

    PubMed  Google Scholar 

  23. Torguson, R., Sabate, M., Deible, R., et al. (2006). Intravascular brachytherapy versus drug-eluting stents for the treatment of patients with drug-eluting stent restenosis. American Journal of Cardiology, 98, 1340–1344.

    Article  PubMed  Google Scholar 

  24. Sakamoto, H., Ishikawa, T., Mutoh, M., et al. (2006). Effectiveness of a sirolimus-eluting stent (Cypher) for diffuse in-stent restenosis inside a bare metal stent. International Heart Journal, 47, 651–661.

    Article  PubMed  Google Scholar 

  25. Pohl, T., Kupatt, C., Steinbeck, G., & Boekstegers, P. (2005). Angiographic and clinical outcome for the treatment of in-stent restenosis with sirolimus-eluting stent compared to vascular brachytherapy. Zeitschrift fur Kardiologie, 94, 405–410.

    Article  CAS  PubMed  Google Scholar 

  26. Iofina E, Radke PW, Skurzewski P, et al. (2005). Superiority of sirolimus eluting stent compared with intracoronary beta radiation for treatment of in-stent restenosis: a matched comparison. Heart 91, 1584–1589.

    Google Scholar 

  27. Feres, F., Munoz, J. S., Abizaid, A., et al. (2005). Comparison between sirolimus-eluting stents and intracoronary catheter-based beta radiation for the treatment of in-stent restenosis. American Journal of Cardiology, 96, 1656–1662.

    Article  CAS  PubMed  Google Scholar 

  28. Saia, F., Lemos, P. A., Hoye, A., et al. (2004). Clinical outcomes for sirolimus-eluting stent implantation and vascular brachytherapy for the treatment of in-stent restenosis. Catheterization and Cardiovascular Intervention, 62, 283–288.

    Article  Google Scholar 

  29. Radke, P. W., Kobella, S., Kaiser, A., et al. (2004). Treatment of in-stent restenosis using a paclitaxel-eluting stent: Acute results and long-term follow-up of a matched-pair comparison with intracoronary beta-radiation therapy. European Heart Journal, 25, 920–925.

    Article  CAS  PubMed  Google Scholar 

  30. Airoldi, F., Rogacka, R., Briguori, C., et al. (2004). Comparison of clinical and angiographic outcome of sirolimus-eluting stent implantation versus cutting balloon angioplasty for coronary in-stent restenosis. American Journal of Cardiology, 94, 1297–1300.

    Article  PubMed  Google Scholar 

  31. Lee, S. W., Park, S. W., Park, D. W., et al. (2007). Comparison of six-month angiographic and three-year outcomes after sirolimus-eluting stent implantation versus brachytherapy for bare metal in-stent restenosis. American Journal of Cardiology, 100, 425–430.

    Article  CAS  PubMed  Google Scholar 

  32. Kim, Y. H., Lee, B. K., Park, D. W., et al. (2006). Comparison with conventional therapies of repeated sirolimus-eluting stent implantation for the treatment of drug-eluting coronary stent restenosis. American Journal of Cardiology, 98, 1451–1454.

    Article  CAS  PubMed  Google Scholar 

  33. Sheiban, I., Sillano, D., Biondi-Zoccai, G., et al. (2009). Incidence and management of restenosis after treatment of unprotected left main disease with drug-eluting stents 70 restenotic cases from a cohort of 718 patients: FAILS (failure in left main study). Journal of the American College of Cardiology, 54, 1131–1136.

    Article  PubMed  Google Scholar 

  34. Dibra, A., Kastrati, A., Alfonso, F., et al. (2007). Effectiveness of drug-eluting stents in patients with bare-metal in-stent restenosis: Meta-analysis of randomized trials. Journal of the American College of Cardiology, 49, 616–623.

    Article  CAS  PubMed  Google Scholar 

  35. Oliver, L. N., Buttner, P. G., Hobson, H., & Golledge, J. (2008). A meta-analysis of randomised controlled trials assessing drug-eluting stents and vascular brachytherapy in the treatment of coronary artery in-stent restenosis. International Journal of Cardiology, 126, 216–223.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Stone, G. W., Moses, J. W., Ellis, S. G., et al. (2007). Safety and efficacy of sirolimus- and paclitaxel-eluting coronary stents. The New England Journal of Medicine, 356, 998–1008.

    Article  CAS  PubMed  Google Scholar 

  37. Spaulding, C., Daemen, J., Boersma, E., Cutlip, D. E., & Serruys, P. W. (2007). A pooled analysis of data comparing sirolimus-eluting stents with bare-metal stents. The New England Journal of Medicine, 356, 989–997.

    Article  CAS  PubMed  Google Scholar 

  38. Kastrati, A., Mehilli, J., Pache, J., et al. (2007). Analysis of 14 trials comparing sirolimus-eluting stents with bare-metal stents. The New England Journal of Medicine, 356, 1030–1039.

    Article  CAS  PubMed  Google Scholar 

  39. Holmes, D. R, Jr, Teirstein, P. S., Satler, L., et al. (2008). 3-year follow-up of the SISR (sirolimus-eluting stents versus vascular brachytherapy for in-stent restenosis) trial. JACC Cardiovascular Intervention, 1, 439–448.

    Article  Google Scholar 

  40. Rodriguez, A. E., & Waksman, R. (2009). Sirolimus-eluting stents or vascular brachytherapy for in-stent restenosis after 3-year follow-up of the SISR (sirolimus-eluting stent versus vascular brachytherapy for in-stent restenosis) trial: A call for caution? JACC Cardiovascular Intervention, 2, 75–76.

    Article  Google Scholar 

  41. Waksman, R., Ajani, A. E., Pinnow, E., et al. (2002). Twelve versus six months of clopidogrel to reduce major cardiac events in patients undergoing gamma-radiation therapy for in-stent restenosis: Washington radiation for in-stent restenosis trial (WRIST) 12 versus WRIST PLUS. Circulation, 106, 776–778.

    Article  CAS  PubMed  Google Scholar 

  42. Silber, S., Albertsson, P., Aviles, F. F., et al. (2005). Guidelines for percutaneous coronary interventions. The task force for percutaneous coronary interventions of the European society of cardiology. European Heart Journal, 26, 804–847.

    Article  PubMed  Google Scholar 

  43. Lu, Y. G., Chen, Y. M., Li, L., Zhao, R. Z., Fu, C. H., & Yan, H. (2011). Drug-eluting stents vs. intracoronary brachytherapy for in-stent restenosis: A meta-analysis. Clinical Cardiology, 34, 344–351.

    Article  PubMed  Google Scholar 

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  1. Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China

    Yuhan Sun, Lang Li, Qiang Su & Yongguang Lu

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Correspondence to Lang Li.

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Sun, Y., Li, L., Su, Q. et al. Comparative Efficacy and Safety of Drug-Eluting Stent and Conventional Therapies in Coronary Heart Disease Patients with In-Stent Restenosis: A Meta-Analysis. Cell Biochem Biophys 68, 211–229 (2014). https://doi.org/10.1007/s12013-013-9692-7

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  • DOI: https://doi.org/10.1007/s12013-013-9692-7

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