Implantation of a drug-eluting stent with a different drug (switch strategy) in patients with drug-eluting stent restenosis. Results from a prospective multicenter study (RIBS III [Restenosis Intra-Stent: Balloon Angioplasty Versus Drug-Eluting Stent])
Fernando Alfonso, Maria J Pérez-Vizcayno, Jaime Dutary, Javier Zueco, Angel Cequier, Arturo García-Touchard, Vicens Martí, Iñigo Lozano, Juan Angel, José M Hernández, José R López-Mínguez, Rafael Melgares, Raúl Moreno, Bernhard Seidelberger, Cristina Fernández, Rosana Hernandez, RIBS-III Study Investigators (under the auspices of the Working Group on Interventional Cardiology of the Spanish Society of Cardiology), F Alfonso, R Hernandez, C Macaya, J Zueco, A Cequier, A García-Touchard, J Goicolea, V Martí, M Sabaté, I Lozano, C Morís, B García, J Angel, J M Hernández, J R López-Minguez, R Melgares, R Moreno, B Seidelberger, L Martinez-Elbal, Fernando Alfonso, Maria J Pérez-Vizcayno, Jaime Dutary, Javier Zueco, Angel Cequier, Arturo García-Touchard, Vicens Martí, Iñigo Lozano, Juan Angel, José M Hernández, José R López-Mínguez, Rafael Melgares, Raúl Moreno, Bernhard Seidelberger, Cristina Fernández, Rosana Hernandez, RIBS-III Study Investigators (under the auspices of the Working Group on Interventional Cardiology of the Spanish Society of Cardiology), F Alfonso, R Hernandez, C Macaya, J Zueco, A Cequier, A García-Touchard, J Goicolea, V Martí, M Sabaté, I Lozano, C Morís, B García, J Angel, J M Hernández, J R López-Minguez, R Melgares, R Moreno, B Seidelberger, L Martinez-Elbal
Abstract
Objectives: This study sought to assess the effectiveness of a strategy of using drug-eluting stents (DES) with a different drug (switch) in patients with DES in-stent restenosis (ISR).
Background: Treatment of patients with DES ISR remains a challenge.
Methods: The RIBS-III (Restenosis Intra-Stent: Balloon Angioplasty Versus Drug-Eluting Stent) study was a prospective, multicenter study that aimed to assess results of coronary interventions in patients with DES ISR. The use of a different DES was the recommended strategy. The main angiographic endpoint was minimal lumen diameter at 9-month follow-up. The main clinical outcome measure was a composite of cardiac death, myocardial infarction, and target lesion revascularization.
Results: This study included 363 consecutive patients with DES ISR from 12 Spanish sites. The different-DES strategy was used in 274 patients (75%) and alternative therapeutic modalities (no switch) in 89 patients (25%). Baseline characteristics were similar in the 2 groups, although lesion length was longer in the switch group. At late angiographic follow-up (77% of eligible patients, median: 278 days) minimal lumen diameter was larger (1.86 ± 0.7 mm vs. 1.40 ± 0.8 mm, p = 0.003) and recurrent restenosis rate lower (22% vs. 40%, p = 0.008) in the different-DES group. At the last clinical follow-up (99% of patients, median: 771 days), the combined clinical endpoint occurred less frequently (23% vs. 35%, p = 0.039) in the different-DES group. After adjustment using propensity score analyses, restenosis rate (relative risk: 0.41, 95% confidence interval [CI]: 0.21 to 0.80, p = 0.01), minimal lumen diameter (difference: 0.41 mm, 95% CI: 0.19 to 0.62, p = 0.001), and the event-free survival (hazard ratio: 0.56, 95% CI: 0.33 to 0.96, p = 0.038) remained significantly improved in the switch group.
Conclusions: In patients with DES ISR, the implantation of a different DES provides superior late clinical and angiographic results than do alternative interventional modalities.
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed