This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2006.10.049v1 49/5/616    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dibra, A. Articles by Schömig, A. Search for Related Content PubMed Articles by Dibra, A. Articles by Schömig, A.

EXPEDITED REVIEW

Effectiveness of Drug-Eluting Stents in Patients With Bare-Metal In-Stent Restenosis

Meta-Analysis of Randomized Trials

Alban Dibra, MD^_*, Adnan Kastrati, MD^_*,_*, Fernando Alfonso, MD, Melchior Seyfarth, MD^_*, Maria-José Pérez-Vizcayno, MD, Julinda Mehilli, MD^_* and Albert Schömig, MD^_*

^_* Deutsches Herzzentrum and 1. Medizinische Klinik rechts der Isar, Technische Universität, Munich, Germany
Clinico San Carlos University Hospital, Madrid, Spain

Manuscript received August 11, 2006; revised manuscript received September 20, 2006, accepted October 1, 2006.

^_* Reprint requests and correspondence: Dr. Adnan Kastrati, Deutsches Herzzentrum, Lazarettstr. 36, 80636 Munich, Germany (Email: kastrati{at}dhm.mhn.de).

OBJECTIVES: We sought to synthesize the available evidence on the effectiveness of drug-eluting stents for bare-metal in-stent restenosis.

BACKGROUND: Although there is clinical evidence that drug-eluting stents are associated with better results than other treatments for in-stent restenosis, they are not yet approved for this indication. Meta-analysis of randomized trials may yield more precise estimates of treatment effects and enable a rapid adoption of effective treatments in clinical practice.

METHODS: Data sources included PubMed and conference proceedings. Prespecified criteria were met by 4 randomized studies comparing sirolimus- or paclitaxel-eluting stents versus balloon angioplasty or vascular brachytherapy in 1,230 patients with bare-metal in-stent restenosis. Studies reported the clinical outcomes of efficacy and safety during a minimum of 9 months. The primary outcome was target lesion revascularization.

RESULTS: No significant heterogeneity was found across trials, thus showing a similar effect size regardless of the use of balloon angioplasty or vascular brachytherapy as comparators. The risk of target lesion revascularization (odds ratio 0.35, 95% confidence interval [CI] 0.25 to 0.49; p < 0.001) and that of angiographic restenosis (odds ratio 0.36, 95% CI 0.27 to 0.49; p = 0.001) were markedly lower in patients treated with drug-eluting stents. There were no differences between patients treated with drug-eluting stents and those treated with other techniques with respect to the composite of death or myocardial infarction (odds ratio 1.04, 95% CI 0.54 to 2.03; p = 0.55).

CONCLUSIONS: Drug-eluting stents are markedly superior to conventional techniques (balloon angioplasty and vascular brachytherapy) and should be considered as first-line treatment for patients with bare-metal in-stent restenosis.

Abbreviations and Acronyms   BA = balloon angioplasty   BMS = bare-metal stent(s)   DES = drug-eluting stent(s)   PES = paclitaxel-eluting stent(s)   SES = sirolimus-eluting stent(s)   TLR = target lesion revascularization

This article has been cited by other articles:

				J. Mehilli, A. Kastrati, R. A. Byrne, O. Bruskina, R. Iijima, S. Schulz, J. Pache, M. Seyfarth, S. Massberg, K.-L. Laugwitz, et al. Paclitaxel- Versus Sirolimus-Eluting Stents for Unprotected Left Main Coronary Artery Disease J. Am. Coll. Cardiol., May 12, 2009; 53(19): 1760 - 1768. [Abstract] [Full Text] [PDF]

				J. Carlsson, S. K. James, J. Lindback, F. Schersten, T. Nilsson, U. Stenestrand, B. Lagerqvist, and for the SCAAR (Swedish Coronary Angiography and An Outcome of Drug-Eluting Versus Bare-Metal Stenting Used According to On- and Off-Label Criteria J. Am. Coll. Cardiol., April 21, 2009; 53(16): 1389 - 1398. [Abstract] [Full Text] [PDF]

				S Habara, K Mitsudo, T Goto, K Kadota, S Fujii, H Yamamoto, H Kato, S Takenaka, Y Fuku, S Hosogi, et al. The impact of lesion length and vessel size on outcomes after sirolimus-eluting stent implantation for in-stent restenosis Heart, September 1, 2008; 94(9): 1162 - 1165. [Abstract] [Full Text] [PDF]

				D. R. Holmes Jr and D. O. Williams Catheter-Based Treatment of Coronary Artery Disease: Past, Present, and Future Circ Cardiovasc Interv, August 1, 2008; 1(1): 60 - 73. [Abstract] [Full Text] [PDF]

				S. R. Dixon, C. L. Grines, and W. W. O'Neill The year in interventional cardiology. J. Am. Coll. Cardiol., June 17, 2008; 51(24): 2355 - 2369. [Full Text] [PDF]

				C. L. Grines Off-label use of drug-eluting stents putting it in perspective. J. Am. Coll. Cardiol., February 12, 2008; 51(6): 615 - 617. [Full Text] [PDF]

				A. N. DeMaria, J. J. Bax, O. Ben-Yehuda, P. Clopton, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, J. D. Knoke, W. Y.W. Lew, J. A.C. Lima, et al. Highlights of the year in JACC 2007. J. Am. Coll. Cardiol., January 29, 2008; 51(4): 490 - 512. [Full Text] [PDF]

				A. Kastrati, A. Dibra, C. Spaulding, G. J. Laarman, M. Menichelli, M. Valgimigli, E. Di Lorenzo, C. Kaiser, I. Tierala, J. Mehilli, et al. Meta-analysis of randomized trials on drug-eluting stents vs. bare-metal stents in patients with acute myocardial infarction Eur. Heart J., November 2, 2007; 28(22): 2706 - 2713. [Abstract] [Full Text] [PDF]

				S. R. Dixon, C. L. Grines, and W. W. O'Neill The Year in Interventional Cardiology J. Am. Coll. Cardiol., July 17, 2007; 50(3): 270 - 285. [Full Text] [PDF]