Comparison of new-generation drug-eluting stents versus drug-coated balloon for in-stent restenosis: a meta-analysis of randomised controlled trials.

Abstract

OBJECTIVE:

The study sought to compare angiographic and clinical outcomes of new-generation drug-eluting stents (DES) versus drug-coated balloon (DCB) in patients with coronary in-stent restenosis (ISR).

DESIGN:

Meta-analysis using data from randomised trial found by searches on PubMed, the Cochrane Library, ClinicalTrials.gov and websites of major cardiovascular congresses.

SETTING:

Only randomised trials comparing DES with DCB were included.

PARTICIPANTS:

Patients with ISR in the included trials.

INTERVENTIONS:

New-generation DES versus DCB.

OUTCOMES:

The angiographic and clinical outcomes including cardiac death, all-cause death, myocardial infarction, target lesion revascularisation (TLR), target vessel revascularisation (TVR), major adverse cardiac events (MACE) and stent thrombosis were investigated.

RESULTS:

Five trials including 913 patients were eligible and included. Pooled analysis in angiographic results identified that new-generation DES were associated with higher acute luminal gain (-0.31 mm, 95% CI -0.42 to -0.20, P<0.001) and lower per cent diameter stenosis (risk ratio (RR): 0.28, 95% CI 0.02 to 0.55, P=0.04). DES significantly reduced the risk of TLR (RR: 1.96, 95% CI 1.17 to 3.28, P=0.01) compared with DCB; however, there was no statistical differences for MACE (RR: 1.21, 95% CI 0.67 to 2.17, P=0.53), myocardial infarction (RR: 1.16, 95% CI 0.55 to 2.48, P=0.69) and cardiac death (RR: 1.80, 95% CI 0.60 to 5.39, P=0.29).

CONCLUSIONS:

Interventions with new-generation DES appear to be associated with significant reduction in per cent diameter stenosis and TLR at short-term follow-up, but had similar MACE, myocardial infarction and cardiac death for patients with coronary ISR compared with DCB. Appropriately powered studies with longer term follow-up are warranted to confirm these findings.

• Authors: Jin-Zan Cai, Yong-Xiang Zhu, Xin-Yu Wang, Christos V Bourantas, Javaid Iqbal, Hao Zhu, Paul Cummins, Sheng-Jie Dong, Anthony Mathur, Yao-Jun Zhang
• Journal: BMJ open (BMJ Open) Vol. 8 Issue 2 Pg. e017231 (02 22 2018) ISSN: 2044-6055 [Electronic] England
• PMID: 29472254 (Publication Type: Comparative Study, Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)
• Copyright: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Topics

• Angioplasty, Balloon, Coronary (adverse effects)
• Cause of Death
• Coronary Angiography
• Coronary Restenosis (therapy)
• Death, Sudden, Cardiac (epidemiology, etiology)
• Drug-Eluting Stents (adverse effects)
• Humans
• Linear Models
• Myocardial Infarction (epidemiology, etiology)
• Odds Ratio
• Prosthesis Design (instrumentation)
• Randomized Controlled Trials as Topic
• Treatment Outcome