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Comparison between drug-coated balloon angioplasty and second-generation drug-eluting stent placement for the treatment of in-stent restenosis after drug-eluting stent implantation

Authors
 In Sook Kang  ;  Islam Shehata  ;  Dong-Ho Shin  ;  Jung-Sun Kim  ;  Byeong-Keuk Kim  ;  Young-Guk Ko  ;  Donghoon Choi  ;  Yangsoo Jang  ;  Myeong-Ki Hong 
Citation
 HEART AND VESSELS, Vol.31(9) : 1405-1411, 2016 
Journal Title
 HEART AND VESSELS 
ISSN
 0910-8327 
Issue Date
2016
MeSH
Aged ; Angioplasty, Balloon, Coronary/adverse effects ; Angioplasty, Balloon, Coronary/instrumentation* ; Angioplasty, Balloon, Coronary/mortality ; Cardiac Catheters* ; Cardiovascular Agents/administration & dosage* ; Coated Materials, Biocompatible* ; Coronary Angiography ; Coronary Artery Disease/diagnostic imaging ; Coronary Artery Disease/mortality ; Coronary Artery Disease/therapy* ; Coronary Restenosis/diagnostic imaging* ; Coronary Restenosis/mortality ; Coronary Restenosis/therapy* ; Drug-Eluting Stents* ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Myocardial Infarction/etiology ; Percutaneous Coronary Intervention/adverse effects ; Percutaneous Coronary Intervention/instrumentation* ; Percutaneous Coronary Intervention/mortality ; Proportional Hazards Models ; Prosthesis Design ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome
Keywords
Angioplasty ; Coronary artery disease ; Restenosis ; Stent
Abstract
Even though drug-coated balloon (DCB) angioplasty has emerged as a treatment option for drug-eluting stent in-stent restenosis (DES-ISR), the most effective treatment strategy for DES-ISR is still under debate. Therefore, we compared long-term clinical outcomes following DCB treatment of DES-ISR with those following 2nd-generation drug-eluting stent (DES) treatment. We identified 248 DES-ISR lesions in 238 patients that were treated with either 2nd-generation DES implantation (n = 56) or DCB angioplasty (n = 192). We compared the incidences of major adverse cardiac events (MACEs) in the two groups during the 2-year period following treatment. MACE was defined as cardiac death, non-fatal myocardial infarction, or target-vessel revascularization. The percentage of patients with diabetes and the mean age of patients in the DCB group were greater than in the DES group. The DCB group also had a smaller reference vessel diameter. The DES group had a larger post-intervention minimal luminal diameter. We found no significant difference in the MACE rate between the two groups during the 2 years following treatment (11.0 % in the DCB group vs. 8.9 % in the DES group, p = 0.660). Reference segment diameter was the only independent predictive factor for MACE in the post-treatment period (hazard ratio 0.35, 95 % confidence interval: 0.15-0.82, p = 0.016). Clinical efficacy of DCB angioplasty for treatment of DES-ISR was comparable to that of 2nd-generation DES implantation as measured by the rate of MACEs in the two groups. Reference segment diameter was the only statistically significant independent predictor for MACE in the 2-year period following treatment.
Full Text
https://link.springer.com/article/10.1007%2Fs00380-015-0741-6
DOI
10.1007/s00380-015-0741-6
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Ko, Young Guk(고영국) ORCID logo https://orcid.org/0000-0001-7748-5788
Kim, Byeong Keuk(김병극) ORCID logo https://orcid.org/0000-0003-2493-066X
Kim, Jung Sun(김중선) ORCID logo https://orcid.org/0000-0003-2263-3274
Shin, Dong Ho(신동호) ORCID logo https://orcid.org/0000-0002-7874-5542
Jang, Yang Soo(장양수) ORCID logo https://orcid.org/0000-0002-2169-3112
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
Hong, Myeong Ki(홍명기) ORCID logo https://orcid.org/0000-0002-2090-2031
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/151898
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