Long-term outcomes of DCB and DES for the treatment of in-stent restenosis in relation to the vessel size

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Catheterization and Cardiovascular Interventions Pub Date : 2024-10-09 DOI:10.1002/ccd.31225

Sylwia Iwańczyk MD, PhD, Rafał Wolny MD, Rafał Januszek MD, PhD, Robert J. Gil MD, PhD, Bernardo Cortese MD, Piotr Kubler MD, PhD, Wojciech Wojakowski MD, PhD, Marek Grygier MD, PhD, Maciej Lesiak MD, PhD, Wojciech Wańha MD, PhD

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Abstract

Background

Percutaneous coronary intervention (PCI) with drug-coated balloons (DCB) or drug-eluting stents (DES) are well-established treatments for in-stent restenosis, however little is known about the impact of vessel size on the outcomes. The study aimed to evaluate the efficacy and safety profile of DCB versus DES in DES in-stent restenosis depending on the vessel size.

Methods

Consecutive patients with DES in-stent restenosis who underwent PCI between January 2010 and February 2018 entered the registry with a long-term follow-up. Patients who received DCB at the index procedure were compared with those who received DES in three subgroups depending on the vessel size (≤2.5 mm; 2.5–3.5 mm; >3.5 mm). Data were analyzed using propensity score matching and Kaplan-Meier estimator plots.

Results

Among 1,374 patients with DES in-stent restenosis, 615 were treated with DES and 759 with DCB. After propensity score matching, we analyzed 752 patients in the DES and DCB groups at a long-term follow-up. The risk of DOCE did not differ significantly between the DES and DCB groups, both in the overall population (HR 0.85; 95%CI [0.58; 1.26], log-rank p = 0.41) and when divided into small (HR 0.84; 95%CI [0.36; 1.95], log-rank p = 0.70), medium-sized (HR 0.90; 95%CI [0.49; 1.65], log-rank p = 0.73), and large-sized (HR 0.81; 95%CI [0.42; 1.53], log-rank p = 0.50) coronary arteries. The incidence of all-cause death was significantly higher in the overall DES population (HR 4.03; 95%CI [2.40; 6.79], log-rank p < 0.001) and subgroup of small (HR 5.54; 95%CI [1.80; 17.02], log-rank p = 0.003), medium-sized (HR 4.37; 95%CI [1.92; 9.94], log-rank p = 0.009) and large-sized coronary arteries (HR 3.26; 95%CI [1.35; 7.86], log-rank p = 0.02).

Conclusions

DES and DCB strategies are comparable methods of treating ISR regardless of the diameter of the treated vessel in a long-term follow-up.

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DCB和DES治疗支架内再狭窄的长期疗效与血管大小有关。

背景：使用药物涂层球囊（DCB）或药物洗脱支架（DES）进行经皮冠状动脉介入治疗（PCI）是治疗支架内再狭窄的行之有效的方法，但人们对血管大小对治疗效果的影响知之甚少。该研究旨在评估DCB与DES治疗DES支架内再狭窄的疗效和安全性，具体取决于血管大小：2010年1月至2018年2月期间接受PCI治疗的DES支架内再狭窄连续患者进入登记册，并进行长期随访。根据血管大小（≤2.5 mm；2.5-3.5 mm；>3.5 mm）分为三个亚组，将在指数手术中接受 DCB 的患者与接受 DES 的患者进行比较。采用倾向评分匹配和卡普兰-梅耶估计图分析数据：在1374名DES支架内再狭窄患者中，615人接受了DES治疗，759人接受了DCB治疗。经过倾向评分匹配后，我们对DES组和DCB组的752名患者进行了长期随访分析。无论是在总体人群中（HR 0.85; 95%CI [0.58; 1.26]，log-rank p = 0.41），还是在分为小群体时（HR 0.84；95%CI [0.36；1.95]，log-rank p = 0.70）、中型（HR 0.90；95%CI [0.49；1.65]，log-rank p = 0.73）和大型（HR 0.81；95%CI [0.42；1.53]，log-rank p = 0.50）冠状动脉。DES人群的全因死亡发生率明显更高（HR 4.03；95%CI [2.40；6.79]，log-rank p 结论：DES和DCB是两种具有可比性的冠状动脉治疗方法：在长期随访中，无论治疗血管的直径如何，DES和DCB都是治疗ISR的可比方法。

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.