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ZJUS-B
Journal of Zhejiang University-SCIENCE B (Biomedicine & Biotechnology)  2010, Vol. 11 Issue (8): 553-560    DOI: 10.1631/jzus.B1001002
Articles     
Efficacy and safety of drug-eluting stent implantation for the treatment of in-stent restenosis occurring within bare-metal stent and drug-eluting stent
Heng Ge, Qing Zhang, Wei Zhou, Qing He, Zhi-hua Han, Ben He
Department of Cardiology, Shanghai Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200001, China, Department of Radiology, Shanghai Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200001, China
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Abstract  Objective: Although drug-eluting stent (DES) implantation is the primary treatment modality for bare-metal stent (BMS) in-stent restenosis (ISR), little is known about the efficacy and safety profile of DES in the treatment of DES-ISR. The goal of this study was to compare the clinical outcomes following DES treatment for BMS-ISR and DES-ISR. Methods: Rates of major adverse cardiac events (MACE) were compared in 97 consecutive patients who underwent DES implantation for the treatment of ISR (56 BMS-ISR and 41 DES-ISR) from January 2004 to December 2008. Results: Baseline clinical and procedural characteristics were comparable, except that the DES used in the BMS-ISR group was longer and had a larger diameter. The length of follow-up was (28.60±1.96) and (20.34±1.54) months for the BMS-ISR and DES-ISR groups, respectively. One patient (1.8%) experienced non-cardiac mortality and one (1.8%) had target-vessel revascularization (TVR) in the BMS-ISR group. In the DES-ISR group, three patients (7.3%) died of sudden death with a documented acute ST-segment elevation myocardial infarction, and three suffered TVR (7.3%). Kaplan-Meier analysis indicated that cumulative survival probability and MACE-free probability were both significantly lower for the DES-ISR group (log rank test P=0.047 and P=0.005, respectively). In Cox regression analysis, DES-ISR remained an independent predictor for future MACE occurrence after adjustment for other factors (compared with BMS-ISR, risk ratio (RR)=8.743, 95% confidence interval (CI) 1.54–49.54, P=0.014). Switching to a different type of DES to treat DES-ISR did not improve the prognosis. Conclusion: DES-ISR patients had a poorer prognosis than BMS-ISR patients after DES therapy.

Key words： Atherosclerosis      In-stent restenosis      Bare-metal stent      Drug-eluting stent     
Received: 09 June 2010      Published: 05 August 2010
CLC:  R54  
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Heng Ge, Qing Zhang, Wei Zhou, Qing He, Zhi-hua Han, Ben He. Efficacy and safety of drug-eluting stent implantation for the treatment of in-stent restenosis occurring within bare-metal stent and drug-eluting stent. Journal of Zhejiang University-SCIENCE B (Biomedicine & Biotechnology), 2010, 11(8): 553-560.

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http://www.zjujournals.com/xueshu/zjus-b/10.1631/jzus.B1001002     OR     http://www.zjujournals.com/xueshu/zjus-b/Y2010/V11/I8/553

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