The Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China. No. 83 Wenhua Road, Shenyang 110840, Liaoning Province, China.
The Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China. No. 83 Wenhua Road, Shenyang 110840, Liaoning Province, China.
Int J Cardiol. 2024 Nov 15;415:132450. doi: 10.1016/j.ijcard.2024.132450. Epub 2024 Aug 13.
Drug-coated balloon (DCB) angioplasty and drug-eluting stents (DES) are two widely used treatments for in-stent restenosis (ISR). Focal and non-focal types of ISR affect the clinical outcomes. The present study aims to compare DES reimplantation versus DCB angioplasty in acute coronary syndrome (ACS) patients with focal ISR and non-focal ISR lesions.
Patients with ISR lesions underwent percutaneous coronary intervention (PCI) were retrospectively evaluated and divided into DES group and DCB group. The primary endpoint was the incidence of target lesion failure (TLF) at 24 months follow up. Propensity score matching (PSM) was conducted to balance the baseline characteristics.
For focal ISR, TLF was comparable in the DES and DCB groups at 24 months of follow-up (Before PSM, hazard ratio [HR]: 0.70; 95% confidence interval [CI]: 0.39-1.27; p = 0.244; After PSM, HR: 0.83; 95% CI: 0.40-1.73; p = 0.625). For non-focal ISR, TLF was significantly decreased in DES compared with DCB group (Before PSM, HR: 0.43; 95% CI: 0.29-0.63; p < 0.001; After PSM, HR: 0.33; 95% CI: 0.19-0.59; p < 0.001), which was mainly attributed to the lower incidence of clinically indicated target lesion revascularization (CD-TLR) (Before PSM, HR: 0.39; 95% CI: 0.26-0.59; p < 0.001; After PSM, HR: 0.28; 95% CI: 0.15-0.54; p < 0.001).
The clinical outcomes for DES and DCB treatment are similar in focal type of ISR lesions. For non-focal ISR, the treatment of DES showed a significant decrease in TLF which was mainly attributed to a lower incidence of CD-TLR.
药物涂层球囊（DCB）血管成形术和药物洗脱支架（DES）是治疗支架内再狭窄（ISR）的两种广泛应用的治疗方法。局灶性和非局灶性 ISR 类型会影响临床结果。本研究旨在比较 DES 再植入与 DCB 血管成形术在急性冠状动脉综合征（ACS）患者局灶性 ISR 和非局灶性 ISR 病变中的应用。
回顾性评估接受经皮冠状动脉介入治疗（PCI）的 ISR 病变患者，并将其分为 DES 组和 DCB 组。主要终点是 24 个月随访时靶病变失败（TLF）的发生率。采用倾向评分匹配（PSM）平衡基线特征。
对于局灶性 ISR，DES 和 DCB 两组在 24 个月的随访中 TLF 无差异（PSM 前，风险比[HR]：0.70；95%置信区间[CI]：0.39-1.27；p=0.244；PSM 后，HR：0.83；95%CI：0.40-1.73；p=0.625）。对于非局灶性 ISR，DES 组的 TLF 明显低于 DCB 组（PSM 前，HR：0.43；95%CI：0.29-0.63；p<0.001；PSM 后，HR：0.33；95%CI：0.19-0.59；p<0.001），主要归因于临床指示的靶病变血运重建（CD-TLR）发生率较低（PSM 前，HR：0.39；95%CI：0.26-0.59；p<0.001；PSM 后，HR：0.28；95%CI：0.15-0.54；p<0.001）。
DES 和 DCB 治疗局灶性 ISR 病变的临床结果相似。对于非局灶性 ISR，DES 治疗可显著降低 TLF，主要归因于 CD-TLR 发生率较低。
