DES, DEB, and Balloon Angioplasty Compared in Management of DES ISR

December 7, 2015—Sachin S. Goel, MD, et al conducted a systematic review and meta-analysis of observations and randomized studies to compare outcomes of management of coronary drug-eluting stents (DES), in-stent restenosis (ISR) using DES, drug-eluting balloons (DEB), or balloon angioplasty (BA). The investigators published the findings online ahead of print in Catheterization and Cardiovascular Interventions.

The investigators identified eligible studies using a MEDLINE search and proceedings of international meetings. They identified 25 single-arm and 13 comparative studies, including four randomized trials with a total of 7,474 patients with DES ISR. 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).

As summarized in Catheterization and Cardiovascular Interventions, the rate of TLR was significantly lower in the DES (odds ratio [OR], 0.5; 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, reported the investigators.

The investigators concluded that 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, stated the investigators in Catheterization and Cardiovascular Interventions.