Drug-eluting balloon versus second-generation drug-eluting stent for the treatment of restenotic lesions involving coronary bifurcations

Toru Naganuma, Azeem Latib, Charis Costopoulos, Jacopo Oreglia, Luca Testa, Federico De Marco, Alessandro Candreva, Alaide Chieffo, Charbel Naim, Matteo Montorfano, Francesco Bedogni, Antonio Colombo

Research output: Contribution to journalArticle

Abstract

AIMS: To report clinical outcomes in patients treated with drug-eluting balloon (DEB) versus second-generation drug-eluting stent (DES) for in-stent restenosis (ISR) involving a bifurcation lesion.

METHODS AND RESULTS: Between February 2007 and November 2012, 167 bifurcation restenoses in 158 patients were treated with either DEB (n=73) or second-generation DES (n=85). The EuroSCORE was significantly higher in the DEB group (4.2±3.8 vs. 2.8±2.1, p=0.004). Regarding restenosed stent type, second-generation DES was more frequently seen in the DEB group (26.9% vs. 6.7%, p<0.001). In this group, there was also a trend towards more frequent stenting for a previous ISR (stent-in-stent) as compared with the DES group (25.6% vs. 15.6%, p=0.074). Over a median follow-up period of 701 days, there was no significant difference in major adverse cardiac events (MACE), defined as cardiac death, myocardial infarction including periprocedural myocardial infarction, target vessel revascularisation, between the two groups (p=0.585). Independent predictors of MACE on multivariate Cox regression analysis included stent-in-stent (HR: 2.16; 95% CI: 1.11 to 4.20; p=0.023) and true bifurcation lesions (HR: 2.98; 95% CI: 1.45 to 6.14; p=0.001).

CONCLUSIONS: DEB for bifurcation restenosis may be an acceptable treatment option, especially in cases where repeat stenting has not already been performed for the treatment of a previous restenosis.

Original languageEnglish
Pages (from-to)989-95
Number of pages7
JournalEuroIntervention
Volume11
Issue number9
DOIs
Publication statusPublished - Jan 22 2016

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Drug-Eluting Stents
Stents
Pharmaceutical Preparations
Therapeutics
Myocardial Infarction
Regression Analysis

Keywords

  • Aged
  • Cardiovascular Agents
  • Chi-Square Distribution
  • Coated Materials, Biocompatible
  • Coronary Angiography
  • Coronary Artery Disease
  • Coronary Restenosis
  • Drug-Eluting Stents
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Infarction
  • Percutaneous Coronary Intervention
  • Proportional Hazards Models
  • Retreatment
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Vascular Access Devices
  • Comparative Study
  • Journal Article

Cite this

Drug-eluting balloon versus second-generation drug-eluting stent for the treatment of restenotic lesions involving coronary bifurcations. / Naganuma, Toru; Latib, Azeem; Costopoulos, Charis; Oreglia, Jacopo; Testa, Luca; De Marco, Federico; Candreva, Alessandro; Chieffo, Alaide; Naim, Charbel; Montorfano, Matteo; Bedogni, Francesco; Colombo, Antonio.

In: EuroIntervention, Vol. 11, No. 9, 22.01.2016, p. 989-95.

Research output: Contribution to journalArticle

Naganuma, Toru ; Latib, Azeem ; Costopoulos, Charis ; Oreglia, Jacopo ; Testa, Luca ; De Marco, Federico ; Candreva, Alessandro ; Chieffo, Alaide ; Naim, Charbel ; Montorfano, Matteo ; Bedogni, Francesco ; Colombo, Antonio. / Drug-eluting balloon versus second-generation drug-eluting stent for the treatment of restenotic lesions involving coronary bifurcations. In: EuroIntervention. 2016 ; Vol. 11, No. 9. pp. 989-95.
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abstract = "AIMS: To report clinical outcomes in patients treated with drug-eluting balloon (DEB) versus second-generation drug-eluting stent (DES) for in-stent restenosis (ISR) involving a bifurcation lesion.METHODS AND RESULTS: Between February 2007 and November 2012, 167 bifurcation restenoses in 158 patients were treated with either DEB (n=73) or second-generation DES (n=85). The EuroSCORE was significantly higher in the DEB group (4.2±3.8 vs. 2.8±2.1, p=0.004). Regarding restenosed stent type, second-generation DES was more frequently seen in the DEB group (26.9{\%} vs. 6.7{\%}, p<0.001). In this group, there was also a trend towards more frequent stenting for a previous ISR (stent-in-stent) as compared with the DES group (25.6{\%} vs. 15.6{\%}, p=0.074). Over a median follow-up period of 701 days, there was no significant difference in major adverse cardiac events (MACE), defined as cardiac death, myocardial infarction including periprocedural myocardial infarction, target vessel revascularisation, between the two groups (p=0.585). Independent predictors of MACE on multivariate Cox regression analysis included stent-in-stent (HR: 2.16; 95{\%} CI: 1.11 to 4.20; p=0.023) and true bifurcation lesions (HR: 2.98; 95{\%} CI: 1.45 to 6.14; p=0.001).CONCLUSIONS: DEB for bifurcation restenosis may be an acceptable treatment option, especially in cases where repeat stenting has not already been performed for the treatment of a previous restenosis.",
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AU - Naganuma, Toru

AU - Latib, Azeem

AU - Costopoulos, Charis

AU - Oreglia, Jacopo

AU - Testa, Luca

AU - De Marco, Federico

AU - Candreva, Alessandro

AU - Chieffo, Alaide

AU - Naim, Charbel

AU - Montorfano, Matteo

AU - Bedogni, Francesco

AU - Colombo, Antonio

PY - 2016/1/22

Y1 - 2016/1/22

N2 - AIMS: To report clinical outcomes in patients treated with drug-eluting balloon (DEB) versus second-generation drug-eluting stent (DES) for in-stent restenosis (ISR) involving a bifurcation lesion.METHODS AND RESULTS: Between February 2007 and November 2012, 167 bifurcation restenoses in 158 patients were treated with either DEB (n=73) or second-generation DES (n=85). The EuroSCORE was significantly higher in the DEB group (4.2±3.8 vs. 2.8±2.1, p=0.004). Regarding restenosed stent type, second-generation DES was more frequently seen in the DEB group (26.9% vs. 6.7%, p<0.001). In this group, there was also a trend towards more frequent stenting for a previous ISR (stent-in-stent) as compared with the DES group (25.6% vs. 15.6%, p=0.074). Over a median follow-up period of 701 days, there was no significant difference in major adverse cardiac events (MACE), defined as cardiac death, myocardial infarction including periprocedural myocardial infarction, target vessel revascularisation, between the two groups (p=0.585). Independent predictors of MACE on multivariate Cox regression analysis included stent-in-stent (HR: 2.16; 95% CI: 1.11 to 4.20; p=0.023) and true bifurcation lesions (HR: 2.98; 95% CI: 1.45 to 6.14; p=0.001).CONCLUSIONS: DEB for bifurcation restenosis may be an acceptable treatment option, especially in cases where repeat stenting has not already been performed for the treatment of a previous restenosis.

AB - AIMS: To report clinical outcomes in patients treated with drug-eluting balloon (DEB) versus second-generation drug-eluting stent (DES) for in-stent restenosis (ISR) involving a bifurcation lesion.METHODS AND RESULTS: Between February 2007 and November 2012, 167 bifurcation restenoses in 158 patients were treated with either DEB (n=73) or second-generation DES (n=85). The EuroSCORE was significantly higher in the DEB group (4.2±3.8 vs. 2.8±2.1, p=0.004). Regarding restenosed stent type, second-generation DES was more frequently seen in the DEB group (26.9% vs. 6.7%, p<0.001). In this group, there was also a trend towards more frequent stenting for a previous ISR (stent-in-stent) as compared with the DES group (25.6% vs. 15.6%, p=0.074). Over a median follow-up period of 701 days, there was no significant difference in major adverse cardiac events (MACE), defined as cardiac death, myocardial infarction including periprocedural myocardial infarction, target vessel revascularisation, between the two groups (p=0.585). Independent predictors of MACE on multivariate Cox regression analysis included stent-in-stent (HR: 2.16; 95% CI: 1.11 to 4.20; p=0.023) and true bifurcation lesions (HR: 2.98; 95% CI: 1.45 to 6.14; p=0.001).CONCLUSIONS: DEB for bifurcation restenosis may be an acceptable treatment option, especially in cases where repeat stenting has not already been performed for the treatment of a previous restenosis.

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KW - Female

KW - Humans

KW - Kaplan-Meier Estimate

KW - Male

KW - Middle Aged

KW - Multivariate Analysis

KW - Myocardial Infarction

KW - Percutaneous Coronary Intervention

KW - Proportional Hazards Models

KW - Retreatment

KW - Retrospective Studies

KW - Risk Factors

KW - Time Factors

KW - Treatment Outcome

KW - Vascular Access Devices

KW - Comparative Study

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VL - 11

SP - 989

EP - 995

JO - EuroIntervention

JF - EuroIntervention

SN - 1774-024X

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