Long-term outcomes following DCB versus thin-strut DES for treatment of in-stent restenosis in acute coronary syndrome
R Januszek, W Wanha, F D'Ascenzo, M Gasior, B Cortese, M Kowalewski, K Reczuch, W Wojakowski, S Iwanczyk, M Lesiak, A Witkowski, S Dobrzycki, R J Gil, L Kuzma, P NiezgodaAbstract
Background
The long-term outcomes of patients with in-stent restenosis (ISR) presenting with Acute Coronary Syndrome (ACS) are not well studied. This study aims at investigating the outcomes of patients with drug-eluting stents (DES)-ISR presenting with ACS undergoing percutaneous coronary intervention (PCI) with DCB or thin strut-DES.
Methods
Consecutive patients from the Dragon-Register with DES-ISR who underwent PCI with thin-DES or paclitaxel-DCB were enrolled [Figure 1]. Primary outcome was target lesion revascularization (TLR). Secondary outcomes were target vessel revascularization (TVR) and device-oriented composite endpoint [DOCE, cardiac death, TLR, and target vessel myocardial infarction (TV-MI)]. Propensity-score matching was used to adjust for baseline differences.
Results
A total of 1,317 patients were included in the pooled analysis of whom 585 (44.4%) were treated with a thin-DES and 732 (55,6%) with drug-coated balloons.
In the crude analysis of patients with ACS (N = 697) undergoing PCI for ISR, thin-DES vs. DCB showed similar outcomes for TLR (HR = 1.21, 95% CI 0.78–1.86; P = 0.400), TVR (HR = 0.91, 95% CI 0.62–1.34; P = 0.641), MI (HR = 1.25, 95% CI 0.82–1.86; P = 0.281), TV-MI (HR = 0.91, 95% CI 0.43–1.90; P = 0.793), CV death (HR = 0.76, 95% CI 0.27–2.09; P = 0.589), and DOCE (HR = 1.04, 95% CI 0.70–1.54; P = 0.840).
After propensity score matching (N = 606), the HRs remained non-significant for TLR (1.08, 95% CI 0.69–1.69; P = 0.731 [Figure 2]), TVR (0.88, 95% CI 0.59–1.31; P = 0.523), MI (1.24, 95% CI 0.80–1.91; P = 0.336), TV-MI (0.93, 95% CI 0.43–2.05; P = 0.865), CV death (0.75, 95% CI 0.26–2.18; P = 0.602), and DOCE (0.98, 95% CI 0.65–1.46; P = 0.904).
Conclusions
In patients with acute coronary syndrome undergoing percutaneous coronary intervention for in-stent restenosis, treatment with thin-DES was associated with a numerical reduction in the rates of TLR and DOCE compared with DCB. However, these differences did not achieve statistical significance in either the crude or propensity score–matched analyses.Figure 1For image description, please refer to the figure legend and surrounding text.Figure 2For image description, please refer to the figure legend and surrounding text.