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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

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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.

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Acknowledgments

This study was supported by a Grant from the Korea Healthcare Technology Research and Development Project, Ministry for Health, Welfare and Family Affairs, Republic of Korea (Nos. A085136 and A102064), the Mid-career Researcher Program through NRF grant funded by the MEST, Republic of Korea (No. 2015R1A2A2A01002731) and the Cardiovascular Research Center, Seoul, Korea.

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    Authors and Affiliations

    1. Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea

      In Sook Kang, Dong-Ho Shin, Jung-Sun Kim, Byeong-Keuk Kim, Young-Guk Ko, Donghoon Choi, Yangsoo Jang & Myeong-Ki Hong

    2. Department of Cardiology, Zagazig University, Zagazig, Egypt

      Islam Shehata

    3. Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 134 Sinchon-dong, Seodaemun-gu, Seoul, 120-752, Korea

      Dong-Ho Shin, Jung-Sun Kim, Byeong-Keuk Kim, Young-Guk Ko, Donghoon Choi, Yangsoo Jang & Myeong-Ki Hong

    4. Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea

      Yangsoo Jang & Myeong-Ki Hong

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    I. S. Kang and I. Shehata contributed equally to this paper.

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    Kang, I.S., Shehata, I., Shin, DH. et al. 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. Heart Vessels 31, 1405–1411 (2016). https://doi.org/10.1007/s00380-015-0741-6

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