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Efficacy of drug-eluting stents for treating in-stent restenosis of drug-eluting stents (from the Korean DES ISR multicenter registry study [KISS]).

Authors
 Young-Guk Ko  ;  Jung-Sun Kim  ;  Byeong-Keuk Kim  ;  Donghoon Choi  ;  Myeong-Ki Hong  ;  Dong Woon Jeon  ;  Joo-Young Yang  ;  Young Keun Ahn  ;  Myung Ho Jeong  ;  Cheol Woong Yu  ;  Kyeong-Ho Yun  ;  Do-Sun Lim  ;  Yangsoo Jang 
Citation
 AMERICAN JOURNAL OF CARDIOLOGY, Vol.109(5) : 607-613, 2012 
Journal Title
 AMERICAN JOURNAL OF CARDIOLOGY 
ISSN
 0002-9149 
Issue Date
2012
MeSH
Angioplasty, Balloon, Coronary/methods* ; Cause of Death/trends ; Coronary Angiography ; Coronary Restenosis/diagnostic imaging ; Coronary Restenosis/epidemiology ; Coronary Restenosis/surgery* ; Drug-Eluting Stents* ; Electrocardiography* ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Middle Aged ; Myocardial Infarction/diagnosis ; Myocardial Infarction/epidemiology* ; Myocardial Infarction/etiology ; Prognosis ; Propensity Score ; Proportional Hazards Models ; Registries* ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Survival Rate/trends ; Treatment Failure ; Treatment Outcome
Keywords
Angioplasty, Balloon, Coronary/methods* ; Cause of Death/trends ; Coronary Angiography ; Coronary Restenosis/diagnostic imaging ; Coronary Restenosis/epidemiology ; Coronary Restenosis/surgery* ; Drug-Eluting Stents* ; Electrocardiography* ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Middle Aged ; Myocardial Infarction/diagnosis ; Myocardial Infarction/epidemiology* ; Myocardial Infarction/etiology ; Prognosis ; Propensity Score ; Proportional Hazards Models ; Registries* ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Survival Rate/trends ; Treatment Failure ; Treatment Outcome
Abstract
There is currently no established standard treatment for in-stent restenosis (ISR) after the implantation of a drug-eluting stent (DES). The aim of this study was to investigate the efficacy of DES versus balloon angioplasty (BA) for the treatment of DES ISR in a multicenter registry cohort. After matching propensity scores of 805 patients with DES ISR treated with either DES (n = 422) or BA (n = 383), 268 matched pairs were selected and analyzed for major adverse cardiac events, a composite of death, myocardial infarction, and target-vessel revascularization, as the primary end point. Baseline clinical and lesion characteristics of the matched pairs were similar. Survival free of major adverse cardiac events at 2 years was higher with DES compared to BA (88.9% vs 78.7%, p <0.001), mainly because of higher TVR-free survival (92.4% vs 81.0%, p <0.001). Among various baseline variables, BA (hazard ratio 2.546, 95% confidence interval 1.412 to 4.593, p = 0.002) was the most important independent risk factor for recurrent target vessel revascularization, followed by acute coronary syndromes as the clinical presentation of DES ISR, and previous implantation of a sirolimus-eluting stent. Survival free of death, myocardial infarction, or stent thrombosis did not differ between the 2 groups. Whereas there was no significant difference in survival free of target vessel revascularization between DES and BA for focal ISR lesions, DES was superior to BA in diffuse ISR lesions (94.3% vs 75.2% at 2 years, p <0.001). In conclusion, compared to BA, the implantation of DES was safe and more effective in the treatment of DES ISR.
Full Text
http://www.sciencedirect.com/science/article/pii/S0002914911031882
DOI
22172241
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
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/22282913/89408
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