Patients with drug-eluting stent- (DES) related in-stent restenosis (ISR) were found to have poorer long-term outcomes than patients with bare-metal stent- (BMS) related ISR, according to results of a meta-analysis published in the Journal of Interventional Cardiology.
Research databases were searched for studies in which clinical outcomes were compared for DES-related ISR (DES-ISR) vs BMS-related ISR (BMS-ISR) in patients treated with DES or drug-eluting balloons (DEB). The 19 selected studies (N=6256; DES-ISR, n=2514; BMS-ISR, n=3742) had a follow-up of 6 months or more, included at least 30 participants, and were randomized or observational. Of the 19 studies examined, 7 and 12 compared DES-ISR with BMS-ISR after treatment with DEB and DES, respectively.
The rate of target lesion revascularization was higher among patients with DES-ISR vs BMS-ISR (risk ratio [RR], 0.53; 95% CI, 0.45-0.64; P <.00001), and so were the risks for: target vessel revascularization (RR, 0.51; 95% CI, 0.40-0.63; P <.00001), stent thrombosis or re-in-stent restenosis (RR, 0.57; 95% CI, 0.44-0.74; P <.0001), major adverse cardiovascular events (RR, 0.63; 95% CI, 0.55-0.72; P <.00001), and cardiac death (RR, 0.58; 95% CI, 0.36-0.93; P =.02). The rates of myocardial infarction tended to be higher among patients with DES-ISR vs BMS-ISR, but not significantly (RR, 0.73; 95% CI, 0.53-1.00; P =.05).
No significant difference in all-cause death was observed between DES-ISR and BMS-ISR groups (RR, 0.83; 95% CI, 0.62-1.11; P =.21).
At the long-term follow-up, instances of target lesion revascularization (P <.00001), major adverse cardiovascular events (P <.00001), target vessel revascularization (P =.0003), and stent thrombosis or re-in-stent restenosis (P =.01) were higher among patients with DES-ISR after DES treatment.
At the long-term follow-up after treatment with DEB, instances of target lesion revascularization (P <.00001), target vessel revascularization (P <.00001), major adverse cardiovascular events (P <.00001), stent thrombosis or re-in-stent restenosis (P =.0007), and cardiac death (P =.02) were higher among patients with DES-ISR.
A limitation of this study was the heterogeneity observed among the studies due to different initial types of DES used.
“Our study demonstrated that patients with DES-ISR had worse clinical outcomes at the long-term follow-up than patients with BMS-ISR after the treatment of DES or DEB, suggesting that DES and DEB may be more effective for BMS-ISR than that for DES-ISR,” concluded the study authors. “Positive prevention of DES-ISR is indispensable and further studies concentrating on detecting the predictors of outcomes of DES-ISR are required.”
Yang Y X, Liu Y, L C P, et al. Clinical outcomes of drug-eluting versus bare-metal in-stent restenosis after the treatment of drug-eluting stent or drug-eluting balloon: A systematic review and meta-analysis. J Interv Cardiol. 2020;8179849. doi:10.1155/2020/8179849