Switching types of drug-eluting stents does not prevent repeated in-stent restenosis in patients with coronary drug-eluting stent restenosis

Autor: Susumu Hattori, Hidenori Adachi, Yoshinori Yasuoka, Tatsuya Sasaki, Kiyoshi Kume, Yasuaki Kohama, Yuhei Nojima, Ryo Matsutera
Rok vydání: 2014
Předmět:
Drug
Male
medicine.medical_specialty
Time Factors
medicine.medical_treatment
media_common.quotation_subject
Coronary Artery Disease
Kaplan-Meier Estimate
Balloon
Coronary Angiography
Prosthesis Design
Risk Assessment
Disease-Free Survival
Coronary artery disease
Coronary Restenosis
Percutaneous Coronary Intervention
Restenosis
Japan
Recurrence
Risk Factors
Angioplasty
medicine
Odds Ratio
Humans
cardiovascular diseases
Angioplasty
Balloon
Coronary
media_common
Aged
Chi-Square Distribution
business.industry
Patient Selection
Percutaneous coronary intervention
Stent
Drug-Eluting Stents
General Medicine
Middle Aged
equipment and supplies
medicine.disease
Surgery
surgical procedures
operative
Treatment Outcome
Drug-eluting stent
Multivariate Analysis
Female
Cardiology and Cardiovascular Medicine
business
Zdroj: Coronary artery disease. 25(8)
ISSN: 1473-5830
Popis: We treated patients experiencing drug-eluting stent (DES) restenosis with plain old balloon angioplasty (POBA), implantation of the same type of DES [homogeneous drug-eluting stent (HOMO-DES)], or implantation of a different type of DES [heterogeneous drug-eluting stent (HETERO-DES)], and compared the efficacy and safety of these procedures for the prevention of repeated in-stent restenosis (ISR).In patients with de-novo coronary lesions, DES implantation is associated with a markedly reduced restenosis rate as compared with that associated with a bare metal stent and POBA. However, the optimal management strategy for patients with DES ISR remains unknown.We identified 191 consecutive DES ISR lesions from 183 patients who required clinically driven revascularization and divided them into three groups according to the treatment: 38 lesions were treated with POBA, 38 with HOMO-DES, and 115 with HETERO-DES.The incidence of target lesion revascularization (TLR) was 42.1% (16/38), 15.8% (6/38), and 16.5% (19/115) in the POBA, HOMO-DES, and HETERO-DES groups (POBA vs. HOMO, HETERO-DES; P=0.002, respectively). Multivariate analysis indicated that diabetes [odds ratio (OR), 3.4], hemodialysis (OR, 7.74), nonfocal ISR patterns (OR, 3.35), previous myocardial infarction (OR, 3.26), and POBA (OR, 8.84) were independent predictors of TLR.A strategy involving repeated DES implantation was superior to POBA for preventing recurrent restenosis. Treatment with a different type or generation of DES does not appear to reduce the incidence of TLR. Moreover, we identified certain useful factors for facilitating appropriate and early triage in the patients with repeated DES ISR.
Databáze: OpenAIRE
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