Percutaneous coronary interventional strategies for treatment of in-stent restenosis: a network meta-analysis.

Siontis, George C M; Stefanini, Giulio G; Mavridis, Dimitris; Siontis, Konstantinos C; Alfonso, Fernando; Pérez-Vizcayno, María J; Byrne, Robert A; Kastrati, Adnan; Meier, Bernhard; Salanti, Georgia; Jüni, Peter; Windecker, Stephan (2015). Percutaneous coronary interventional strategies for treatment of in-stent restenosis: a network meta-analysis. Lancet, 386(9994), pp. 655-664. Elsevier 10.1016/S0140-6736(15)60657-2

[img] Text
Siontis Lancet 2015.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (391kB) | Request a copy

BACKGROUND Percutaneous coronary intervention (PCI) with drug-eluting stents is the standard of care for treatment of native coronary artery stenoses, but optimum treatment strategies for bare metal stent and drug-eluting stent in-stent restenosis (ISR) have not been established. We aimed to compare and rank percutaneous treatment strategies for ISR. METHODS We did a network meta-analysis to synthesise both direct and indirect evidence from relevant trials. We searched PubMed, the Cochrane Library Central Register of Controlled Trials, and Embase for randomised controlled trials published up to Oct 31, 2014, of different PCI strategies for treatment of any type of coronary ISR. The primary outcome was percent diameter stenosis at angiographic follow-up. This study is registered with PROSPERO, number CRD42014014191. FINDINGS We deemed 27 trials eligible, including 5923 patients, with follow-up ranging from 6 months to 60 months after the index intervention. Angiographic follow-up was available for 4975 (84%) of 5923 patients 6-12 months after the intervention. PCI with everolimus-eluting stents was the most effective treatment for percent diameter stenosis, with a difference of -9·0% (95% CI -15·8 to -2·2) versus drug-coated balloons (DCB), -9·4% (-17·4 to -1·4) versus sirolimus-eluting stents, -10·2% (-18·4 to -2·0) versus paclitaxel-eluting stents, -19·2% (-28·2 to -10·4) versus vascular brachytherapy, -23·4% (-36·2 to -10·8) versus bare metal stents, -24·2% (-32·2 to -16·4) versus balloon angioplasty, and -31·8% (-44·8 to -18·6) versus rotablation. DCB were ranked as the second most effective treatment, but without significant differences from sirolimus-eluting (-0·2% [95% CI -6·2 to 5·6]) or paclitaxel-eluting (-1·2% [-6·4 to 4·2]) stents. INTERPRETATION These findings suggest that two strategies should be considered for treatment of any type of coronary ISR: PCI with everolimus-eluting stents because of the best angiographic and clinical outcomes, and DCB because of its ability to provide favourable results without adding a new stent layer. FUNDING None.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

UniBE Contributor:

Stefanini, Giulio; Meier, Bernhard; Jüni, Peter and Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0140-6736

Publisher:

Elsevier

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

05 Nov 2015 10:06

Last Modified:

09 Nov 2015 15:23

Publisher DOI:

10.1016/S0140-6736(15)60657-2

PubMed ID:

26334160

BORIS DOI:

10.7892/boris.72882

URI:

https://boris.unibe.ch/id/eprint/72882

Actions (login required)

Edit item Edit item
Provide Feedback