A meta-analysis of randomised controlled trials assessing drug-eluting stents and vascular brachytherapy in the treatment of coronary artery in-stent restenosis
Journal Publication ResearchOnline@JCUAbstract
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.
Journal
International Journal of Cardiology
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Volume
126
ISBN/ISSN
1874-1754
Edition
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Issue
2
Pages Count
8
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Publisher
Elsevier
Publisher Url
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Publisher Location
Coclare, Ireland
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Date
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EISSN
N/A
DOI
10.1016/j.ijcard.2007.03.132