First-generation drug-eluting stents have been proved to be very effective for the
treatment of bare metal stent in-stent restenosis (BMS ISR). The efficacy of second-generation
drug-eluting stents in this setting remains less well defined. The present study compared
the long-term clinical outcome after treatment of BMS ISR using the second-generation
everolimus-eluting stent (EES) to that after treatment using the paclitaxel-eluting
stent (PES). A total of 174 patients with BMS ISR underwent percutaneous coronary
intervention using a PES (95 patients) or an EES (79 patients) from 2003 to 2010.
The patients in the PES and EES groups were followed up for 42.2 ± 22.2 and 18.3 ±
8.2 months, respectively. The primary end point of the study was survival free of
major adverse cardiac events at 1 year. The secondary end points were survival free
of the need for revascularization of the target lesion and definite stent thrombosis.
The baseline clinical and angiographic parameters were comparable between the 2 groups.
The freedom from major adverse cardiac event rate at 1 year of follow-up was 4.5%
and 13.6% (p = 0.0663) for the EES and PES groups, respectively. The target lesion
revascularization (TLR) rates were greater in the PES group at 1 year of follow-up
compared to the EES group (1% vs 11.5%, p = 0.0193). The rate of myocardial infarction,
death, and definite stent thrombosis for the EES and PES groups at 1 year of follow-up
was 0% versus 4.2% (p = 0.0984), 3% versus 2.1% (p = 0.6855), and 0% versus 2.1% (p
= 0.2382), respectively. The use of a PES for treatment of ISR was the only independent
predictor of recurrent TLR at 1 year of follow-up (odds ratios 1.11, 95% confidence
interval 1.05 to 1.18; p = 0.0193). During the complete follow-up period, the rates
of TLR, myocardial infarction, death, major adverse cardiac events, and definite stent
thrombosis were not different between the 2 treatment groups. In conclusion, EES resulted
in reduced rates of TLR at 1 year of follow-up compared to PES when used for treatment
of BMS ISR. However, at long-term follow-up, the event rates between EES and PES were
comparable after treatment of BMS ISR.
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Article Info
Publication History
Published online: May 30, 2011
Accepted:
March 29,
2011
Received:
February 18,
2011
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
