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Safety and efficacy of limus-eluting stents and balloon angioplasty for sirolimus-eluting in-stent restenosis.

Ota, H, Mahmoudi, M, Kitabata, H, Torguson, R, Chen, F, Satler, LF, Suddath, WO, Pichard, AD and Waksman, R (2015) Safety and efficacy of limus-eluting stents and balloon angioplasty for sirolimus-eluting in-stent restenosis. Cardiovasc Revasc Med, 16 (2). pp. 84-89.

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OBJECTIVES: The aim of this study was to compare the safety and efficacy of everolimus-eluting stent (EES), sirolimus-eluting stent (SES), and plain old balloon angioplasty (POBA) for the treatment of SES in-stent restenosis (S-ISR). BACKGROUND: The optimal treatment for drug-eluting in-stent restenosis remains controversial. METHODS: The study cohort comprised 310 consecutive patients (444 lesions) who presented with S-ISR to our institution and underwent treatment with EES (43 patients), SES (102), or POBA (165). The analyzed clinical parameters were the 1-year rates of death, Q-wave myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), definite stent thrombosis (ST) and major adverse cardiac event (MACE) defined as the composite of death, MI, or TLR at 1-year. RESULTS: The three groups were well matched for the conventional risk factors for coronary artery disease except for smoking. The 1-year analyzed clinical parameters were similar in the three groups: MACE (EES=14%, SES=18%, POBA=20%; p=0.65), death (EES=2.3%, SES=6.2%, POBA=6.1%; p=0.61), MI (EES=4.8%, SES=2.1%, POBA=2.5%; p=0.69), TLR (EES=11.9%, SES=12.1%, POBA=24%; p=0.78), and TVR (EES=11.9%, SES=24.8%, POBA=22.2%; p=0.23). There were no cases of definite ST. MACE-free rate was significantly lower in patients with recurrent in-stent restenosis (log-rank p=0.006). Presentation with acute MI, number of treated lesions and a previous history of MI were found to be independent predictors of MACE. CONCLUSIONS: In patients presenting with S-ISR, treatment with implantation of an EES, SES, or POBA is associated with similar clinical outcomes. Patients presenting with recurrent ISR may have a poorer clinical outcome.

Item Type: Article
Divisions : Surrey research (other units)
Authors :
Ota, H
Kitabata, H
Torguson, R
Chen, F
Satler, LF
Suddath, WO
Pichard, AD
Waksman, R
Date : March 2015
DOI : 10.1016/j.carrev.2015.01.004
Uncontrolled Keywords : Everolimus-eluting stent, In-stent restenosis, Plain old balloon angioplasty, Sirolimus-eluting stent, Aged, Angioplasty, Balloon, Coronary, Cohort Studies, Confidence Intervals, Coronary Angiography, Coronary Restenosis, Coronary Stenosis, Drug-Eluting Stents, Everolimus, Female, Follow-Up Studies, Humans, Male, Middle Aged, Multivariate Analysis, Patient Safety, Proportional Hazards Models, Retreatment, Retrospective Studies, Risk Assessment, Sirolimus, Statistics, Nonparametric, Survival Rate, Time Factors, Treatment Outcome
Related URLs :
Depositing User : Symplectic Elements
Date Deposited : 17 May 2017 10:31
Last Modified : 24 Jan 2020 19:29

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