A meta-analysis of randomised controlled trials assessing drug-eluting stents and vascular brachytherapy in the treatment of coronary artery in-stent restenosis

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:126

Article

Oliver, Lisa N.¹  Buttner, Petra G.²  Hobson, Helen¹  Golledge, Jonathan¹ 

[1] James Cook Univ N Queensland, Vasc Biol Unit, Townsville, Qld 4811, Australia

[2] James Cook Univ N Queensland, Sch Publ Hlth & Trop Med, Townsville, Qld 4811, Australia

关键词: in-stent restenosis;    vascular brachytherapy;    drug-eluting stent;   

DOI  :  10.1016/j.ijcard.2007.03.132

来源: Elsevier

【 摘 要 】

Objective: We undertook a meta-analysis of randomised trials assessing the outcome of vascular brachytherapy (VBT) or DES for the treatment of coronary artery ISR. Methods and results: Studies utilising DES or VBT for ISR were identified by a systematic search. Data was pooled and combined overall effect measures were calculated for a random effect model in terms of deaths, myocardial infarctions, revascularisation, binary restenosis, mean late luminal loss and major adverse cardiac events ( MACE). Fourteen eligible studies ( 3103 patients) were included. Neither therapy had any effect on mortality or myocardial infarction rate. VBT reduced the rate of revascularisation (RR 0.59, 95% CI 0.50-0.68), MACE ( RR 0.58, 95% CI 0.51-0.67), binary restenosis ( RR 0.51, 95% CI 0.44-0.59) and late loss (-0.73 mm, 95% CI-0.91 to -0.55 mm) compared to balloon angioplasty and selective bare metal stents (BMS) alone at intermediate follow-up and MACE ( RR 0.72, 95% CI 0.61-0.85) at long-term follow-up. DES reduced the rate of revascularisation ( OR 0.51, 95% CI 0.36-0.71), MACE ( OR 0.55, 95% CI 0.39-0.79) and binary restenosis ( OR 0.57, 95% CI 0.40-0.81) compared to VBT but follow-up was limited to 9 months. Conclusions: VBT improves the long-term outcome of angioplasty compared with BMS alone in the treatment of ISR. DES appears to provide similar results to that of VBT during short-term follow-up. (c) 2007 Elsevier Ireland Ltd. All rights reserved.

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