A comparison of drug-eluting stent versus balloon angioplasty in patients with bare-metal stent instent restenosis: 5 year outcomes

ObjectivesThe objective of the present study was to compare the long term outcomes of balloon angioplasty (BA) versus drug-eluting stents (DES) in bare-metal stent in-stent restenosis (BMS-ISR).BackgroundCoronary in-stent restenosis (ISR) remains a significant clinical problem. Long term results after management of ISR may help improve treatment strategies.MethodsWe assessed 5-year clinical outcomes in cohort of 269 patients with BMS-ISR treated with DES (n = 154) and BA (n = 115) between June 2007 and January 2010 at our institution.ResultsClinical and demographic characteristics were similar for both groups. Mehran classification was used to classify ISR lesions. BA were used predominantly in classes I and II, whereas classes III and IV were treated with DES (p < 0.0001). Percentages of major adverse cardiovascular events (MACE) including death, myocardial infarction (MI) and target vessel revascularization (TVR) for 4.37 ± 1.1 years were 50.4% and 31.8% for the BA and DES groups, respectively (p = 0.002). Although patients in the BA group had significantly higher rates of recurrent angina (42.6% vs. 27.3%, p = 0.009) and TVR (37.4% vs. 20.8%, p = 0.003), MI (6.1% vs. 5.2%, p = 0.752) and cardiac death (21.7% vs. 16.2%, p = 0.251) were similar in both groups. MACE-free 1-year survival and 5-year survival rates were significantly higher in DES group compared to BA group (1 year survival: 91.6% vs. 71.3 p < 0.001, and 5 year survival: 68.2% vs. 49.6%, p < 0.0001, respectively).ConclusionsAlthough DES were more frequently used in to treat complicated lesions in patients with ISR, follow-up MACE rates were significantly lower and MACE-free survival was significantly better in the DES treated patients.

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