RIBS III: Superior late clinical, angiographic results with DES switch strategy

Patients with drug-eluting stent in-stent restenosis achieved superior late angiographic and clinical results after implantation of a different drug-eluting stent — a switch strategy — as compared with results observed with alternative interventions.

The prospective RIBS III study looked at 363 consecutive patients with DES in-stent restenosis at 12 sites in Spain. Three-quarters of patients underwent the DES switch strategy and the rest underwent alternative interventional modalities.

At late angiographic follow-up (77% of patients; median, 278 days), the main angiographic endpoint of minimal lumen diameter was larger in the DES switch strategy group (1.86 mm vs. 1.4 mm; P=.003). The recurrent restenosis rate was also lower with this strategy (22% vs. 40%; P=.008).

Last clinical follow-up (99% of patients; median, 771 days) revealed that the combined clinical endpoint — composite of cardiac death, MI and target lesion revascularization — was less frequent after the DES switch strategy compared with alternative interventions (23% vs. 35%; P=.039).

Restenosis rate (RR=0.41; 95% CI, 0.21-0.8), minimal lumen diameter (difference: 0.41 mm; 95% CI, 0.19-0.62) and event-free survival (HR=0.56; 95% CI, 0.33-0.96) remained significantly improved in the DES switch strategy group after adjustment using propensity score analyses, according to the study.

Further, results of a landmark analysis of all patients showed that the appearance of very late adverse clinical events was similar in both groups after 1 year, “although numerically lower in the different-DES arm” (17% vs. 22%; P=.7). The DES switch strategy was also associated with better angiographic results and a trend toward better clinical outcomes in this analysis.

The two groups studied were similar at baseline, although lesion length was longer in the DES switch strategy group.

DES with different drugs but within the same family (limus) were considered as different DES, according to the abstract.

Fernando Alfonso, MD, an interventional cardiologist at Hospital Universitario Clinico San Carlos, Madrid, Spain, and colleagues conducted the RIBS III study because “treatment of patients with DES in-stent restenosis remains a technical and clinical challenge, and the intervention of choice for these patients remains unsettled.”

According to the researchers, RIBS III is the first large, multicenter study to evaluate implantation of a different DES in this patient group. They also noted that the study results “represent the longest clinical and angiographic follow-up currently available of the different-DES strategy.”

“This experience underscores the value of investigating real-world methods of hemostasis via analysis of data collected in observational registries such as those within the NCDR,” the researchers said.

For more information:

Alfonso F. J Am Coll Cardiol Intv. 2012;5:728-737.

Disclosure: Dr. Alfonso and colleagues report no relevant financial disclosures.