Goals We compared the long-term outcomes of drug-eluting stents (DES) versus

Goals We compared the long-term outcomes of drug-eluting stents (DES) versus bare-metal stents (BMS) for treatment of bare-metal in-stent restenosis (ISR). ISR and met our study criteria. Of the 706 patients with bare-metal ISR 362 were treated with DES and 344 with BMS. There were 230 cumulative events for a median follow-up of 3.2 years. After adjusting for 27 variables DES were associated with lower primary endpoint compared to BMS for treatment of bare-metal ISR (21% versus 45% adjusted hazard ratio [HR] 0.63; 95% confidence interval [CI] AZD8931 0.42 AZD8931 p = 0.03). The individual secondary endpoint of death (8% versus 24% p = 0.005) favored DES but MI (3% versus 8% p = 0.31) and TLR (13% versus 20% p = 0.23) failed to reach statistical significance. Conclusions Inside our multivariate evaluation of individuals with bare-metal ISR DES make use of was connected with considerably lower loss of life MI or TLR in comparison with BMS. Keywords: in-stent restenosis drug-eluting stents bare-metal stents vascular brachytherapy revascularization Intro In-stent restenosis (ISR) is still one of the most common undesirable occasions after stenting influencing 15-35% of lesions treated with bare-metal stents (BMS) (1-5). Bare-metal ISR isn’t a harmless entity and continues to be connected with both poor success and severe coronary syndromes (6-8). Presently regional Rabbit Polyclonal to MMP-11. vascular brachytherapy together with balloon angioplasty may be the just U.S. Meals and Medication Administration approved technique to deal with ISR (1 9 Nevertheless its use continues to be limited because of logistical and monetary challenges worries of radiation publicity evidence of advantage restenosis past due “catch-up” restenosis phenomenon and its association with late thrombosis (1 12 13 Other modalities such as atherectomy cutting balloon angioplasty and laser have not shown incremental advantage over balloon angioplasty for ISR (14-16). Treatment of bare-metal ISR with BMS improved both short- and long-term restenosis rates in vessels ≥3 mm when compared to balloon angioplasty alone (17 18 However this strategy remains associated with a significant restenosis rate of 20% at 1 year and 25% at 4 years (17 18 Drug eluting stents (DES) reduce the rate of restenosis by over 70% compared to BMS in native coronary lesions (19 20 Therefore currently DES placement is believed to be the preferred percutaneous strategy for treating bare-metal ISR (1 21 However to date no randomized controlled trials (RCT) have compared DES versus BMS for treating bare-metal ISR. Additionally there are no observational studies that directly compare DES to BMS for treating bare-metal ISR. Methods Study population We conducted a retrospective analysis on prospectively collected data from the percutaneous coronary intervention (PCI) registry at Cleveland Clinic in patients who underwent PCI for ISR between 05/1999 through 06/2007. Baseline characteristics angiographic data and medications are collected at the time of PCI by trained research coordinators as part of this ongoing AZD8931 registry. The institutional review board waived requirements for informed consent for this institutional PCI registry. Angiographic characteristics We defined in-stent restenosis as any within stent or stent edge restenosis as previously established by Mehran and colleagues (25). Procedural and pharamacotherapy characteristics are captured prospectively. Similarly information regarding balloon pre-dilation stent size stent length maximum balloon dilatation for stent deployment AZD8931 number of stents per case residual stenosis and other important angiographic AZD8931 features were also captured prospectively. Once DES were commercially available in 2003 the choice of stent type (DES versus BMS) was at the discretion of the operator performing the procedure. Clinical End-points The primary end point was a composite of all-cause mortality myocardial infarction (MI) and target lesion revascularization (TLR). The secondary endpoints were individual components of the primary endpoint. Myocardial infarction was defined as occurrence of troponin elevation with electrocardiographic changes or angina. Peri-procedural MI was defined as peri-procedural rise in creatine kinase-MB ≥ 3 times the upper limit of normal (8.8 ng/ml) or MI requiring hospitalization. Patients were.