ABSTRACT

Objectives: The objective of the present study was to compare the long term outcomes of balloon angioplasty (BA) versus drug-eluting stents (DES) in bare-metal stent in-stent restenosis (BMS-ISR). Background: Coronary in-stent restenosis (ISR) remains a significant clinical problem. Long term results after management of ISR may help improve treatment strategies. Methods: We assessed 5-year clinical outcomes in cohort of 269 patients with BMS-ISR treated with DES (n = 154) and BA (n = 115) between June 2007 and January 2010 at our institution. Results: Clinical and demographic characteristics were similar for both groups. Mehran classification was used to classify ISR lesions. BA were used predominantly in classes I and II, whereas classes III and IV were treated with DES (p b 0.0001). Percentages of major adverse cardiovascular events (MACE) including death, myocardial in- farction (MI) and target vessel revascularization (TVR) for 4.37 ± 1.1 years were 50.4% and 31.8% for the BA and DES groups, respectively (p = 0.002). Although patients in the BA group had significantly higher rates of re- current angina (42.6% vs. 27.3%, p = 0.009) and TVR (37.4% vs. 20.8%, p = 0.003), MI (6.1% vs. 5.2%, p = 0.752) and cardiac death (21.7% vs. 16.2%, p = 0.251) were similar in both groups. MACE-free 1-year survival and 5-year survival rates were significantly higher in DES group compared to BA group (1 year survival: 91.6% vs. 71.3 p b 0.001, and 5 year survival: 68.2% vs. 49.6%, p b 0.0001, respectively). Conclusions: Although DES were more frequently used in to treat complicated lesions in patients with ISR, follow- up MACE rates were significantly lower and MACE-free survival was significantly better in the DES treated patients.

Keywords: Bare metal stent Drug eluting stent Coronary revascularization Saphenous vein graft