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DES linked to lower TVR, mortality rates in patients treated for in-stent restenosis
As coronary interventions for in-stent restenosis have increased, drug-eluting stents are associated with lowest target vessel revascularization rates and overall mortality, according to findings published in Catheterization and Cardiovascular Interventions.
“Although the development of coronary stents with thinner struts and novel antiproliferative medications have significantly reduced the incidence of restenosis, contemporary analyses have confirmed that this remains a clinical challenge, with up to 31% of patients receiving DES ultimately undergoing repeat target lesion revascularization within 10 years of the index procedure,” Stephen W. Waldo, MD, from the department of medicine at the VA Eastern Colorado Health Care System in Denver, and colleagues wrote. “The continued occurrence of [in-stent restenosis] highlights the importance of identifying the most effective percutaneous treatment options for this population.”
To evaluate the temporal trends in incidence and procedural management of coronary restenosis and evaluate the link between different treatment modalities and clinical outcomes, Waldo and colleagues conducted a study consisting of patients treated for coronary in-stent restenosis, within the U.S. Department of Veterans Affairs health care system between October 2006 and September 2014.
The researchers created a propensity-matched cohort among patients treated among single vessel restenosis, comparing those treated with DES vs. other treatment modalities. The researchers then compared TVR and mortality between the two subpopulations.
A total of 65,443 patients underwent PCI and 6,872 patients with 8,921 lesions were treated for in-stent restenosis.
Researchers found an annual 0.28% increase of patient revascularization for restenosis (P=.055).
Among the 6,231 patients in the propensity-matched cohort, the rates of TVR (subdistribution HR = 0.623; 95% CI, 0.511-0.76) and mortality (HR = 0.73; 95% CI, 0.641-0.83) among patients treated with a DES were significantly lower than among patients who had other treatments.
DES treatment remained linked to reduced mortality rates after adjusting for known risk factors (adjusted HR = 0.802; 95% CI, 0.704-0.913).
“These data provide important information when evaluating novel therapies for coronary restenosis, including drug-eluting scoring balloons that have demonstrated promise in preliminary studies or bioabsorbable vascular scaffolds that are currently investigated in ongoing clinical trials.” – by Dave Quaile
Disclosure: Waldo reports receiving research support from Cardiovascular Systems Inc. and Merck Pharmaceuticals. Please see the full study for a list of the other authors’ relevant financial disclosures.