A meta-analysis of randomised controlled trials assessing drug-eluting stents and vascular brachytherapy in the treatment of coronary artery in-stent restenosis

Oliver, Lisa N., Buttner, Petra G., Hobson, Helen, and Golledge, Jonathan (2008) A meta-analysis of randomised controlled trials assessing drug-eluting stents and vascular brachytherapy in the treatment of coronary artery in-stent restenosis. International Journal of Cardiology, 126 (2). pp. 216-223.

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Abstract

Objective: We undertook a meta-analysis of randomised trials assessing the outcome of vascular brachytherapy (VBT) or DES for the treatment of coronary artery ISR.

Methods and results: Studies utilising DES or VBT for ISR were identified by a systematic search. Data was pooled and combined overall effect measures were calculated for a random effect model in terms of deaths, myocardial infarctions, revascularisation, binary restenosis, mean late luminal loss and major adverse cardiac events (MACE). Fourteen eligible studies (3103 patients) were included. Neither therapy had any effect on mortality or myocardial infarction rate. VBT reduced the rate of revascularisation (RR 0.59, 95%CI 0.50–0.68), MACE (RR 0.58, 95%CI 0.51–0.67), binary restenosis (RR 0.51, 95%CI 0.44–0.59) and late loss (− 0.73 mm, 95%CI − 0.91 to − 0.55 mm) compared to balloon angioplasty and selective bare metal stents (BMS) alone at intermediate follow-up and MACE (RR 0.72, 95%CI 0.61–0.85) at long-term follow-up. DES reduced the rate of revascularisation (OR 0.51, 95% CI 0.36–0.71), MACE (OR 0.55, 95% CI 0.39–0.79) and binary restenosis (OR 0.57, 95% CI 0.40–0.81) compared to VBT but follow-up was limited to 9 months.

Conclusions: VBT improves the long-term outcome of angioplasty compared with BMS alone in the treatment of ISR. DES appears to provide similar results to that of VBT during short-term follow-up.

Item ID: 6431
Item Type: Article (Refereed Research - C1)
Keywords: in-stent restenosis; vascular brachytherapy; drug-eluting stent
ISSN: 1874-1754
Date Deposited: 15 Mar 2010 01:18
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1102 Cardiovascular Medicine and Haematology > 110201 Cardiology (incl Cardiovascular Diseases) @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920103 Cardiovascular System and Diseases @ 100%
Citation Count from Web of Science Web of Science 9
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