Drug-eluting stent vs. Balloon angioplasty in patients with in-stent restenosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Department

Medicine

Document Type

Article

Publication Title

International Journal of Cardiology

Abstract

Introduction: In-stent restenosis (ISR) is seen in up to 20% of cases and is the primary cause of percutaneous coronary intervention (PCI) failure. With the use of re-stenting with a drug-eluting stent (DES), plain old balloon angioplasty (BA) use is decreasing. We aim to compare the efficacy and safety profile of DES over BA in the management of ISR.

Methods: Electronic databases were searched to identify all randomized controlled trials (RCTs) comparing DES to BA for coronary ISR. The mantel-Haenszel method with a random effects model was used to calculate pooled risk ratios (RR).

Results: Four trials comprising 912 patients (543 in DES and 369 in the BA group) were included in the final study. The mean follow-up was 45 months. DES was found to be superior with a lower requirement of target vessel revascularization (TVR) (RR: 0.45, 95% CI: 0.31-0.64, p-value < 0.0001), and target lesion revascularization (TLR) (RR: 0.59, 95%CI: 0.44-0.78, p-value 0.0002) compared to BA. However, all-cause mortality, cardiovascular mortality, incidence of myocardial infarction (MI), and target lesion thrombosis were not different between the two intervention arms.

Conclusion: DES was found to be superior to BA for the management of coronary ISR with a reduction in the risk of TLR and TVR. No difference in mortality, risk of MI, or target lesion thrombosis was observed between the two interventions.

First Page

132269

DOI

10.1016/j.ijcard.2024.132269

Volume

412

Publication Date

10-1-2024

Medical Subject Headings

Humans; Angioplasty, Balloon, Coronary (methods, adverse effects, instrumentation); Coronary Restenosis (epidemiology, etiology); Drug-Eluting Stents (adverse effects); Percutaneous Coronary Intervention (methods, adverse effects); Randomized Controlled Trials as Topic (methods); Treatment Outcome

PubMed ID

38880417

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