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- Title
Long-term outcomes following paclitaxel-coated balloons versus thin-strut drug-eluting stents for treatment of in-stent restenosis in chronic coronary syndrome (CCS Dragon-Registry).
- Authors
Wańha, Wojciech; D'Ascenzo, Fabrizio; Kuźma, Łukasz; Januszek, Rafał; Iwańczyk, Sylwia; Tomasiewicz, Brunon; Brzozowski, Piotr; Niezgoda, Piotr; Kowalewski, Mariusz; Jaguszewski, Miłosz; Wybraniec, Maciej; Tomaniak, Mariusz; Pindlowski, Patryk; Kochman, Janusz; Kubler, Piotr; Dobrzycki, Sławomir; Bartuś, Stanisław; Lesiak, Maciej; Gąsior, Mariusz; Witkowski, Adam
- Abstract
Background: The long-term outcomes for patients with in-stent restenosis (ISR) presenting with chronic coronary syndrome (CCS) are not well studied. Aims: We aimed to investigate the outcomes for patients with drug-eluting stents (DES)-ISR and CCS undergoing percutaneous coronary intervention (PCI) with drug-coated balloons (DCB) or thin strut-DES. Methods: A total of 846 consecutive patients from the Dragon-Registry with CCS and DES-ISR who underwent PCI with thin (strut thickness <100 µm) strut-DES (381 [45%]) or paclitaxel-DCB (465 [55%]) for DES-ISR were enrolled between February 2008 and October 2021. The median follow-up was 1006 (IQR 426-1770) days. The primary outcome was target lesion revascularization (TLR). Secondary outcomes were target vessel revascularization (TVR) and device-oriented composite endpoint (DOCE: cardiac death, TLR, or target vessel myocardial infarction [TV-MI]). Results: Patients who received DES, compared with those who received DCB, had lower crude rates of TLR (hazard ratio [HR], 0.50 [95% CI, 0.34-0.74]; P <0.001), TVR (HR, 0.56 [95% CI, 0.39-0.86]; P <0.001), and DOCE (HR, 0.63 [95% CI, 0.45-0.88]; P = 0.007). The incidence of cardiac death and TV-MI were similar in both groups. After matching, the observed differences persisted in terms of TLR (HR, 0.54 [95% CI, 0.33-0.88]; P = 0.013), TVR (HR, 0.57 [95% CI, 0.41-0.80]; P = 0.009) and DOCE (HR, 0.65 [95% CI, 0.42-0.99]; P = 0.046) between the DES and DCB groups, respectively. Conclusions: In long-term follow-up of CCS patients undergoing PCI of ISR, the use of DES was associated with reduced rates of TLR, TVR, and DOCE compared with patients treated with DCB.
- Subjects
TRANSLUMINAL angioplasty; MYOCARDIAL infarction; MYOCARDIAL ischemia; PATIENT safety; STATISTICAL hypothesis testing; CLINICAL trials; LOGISTIC regression analysis; CORONARY restenosis; TREATMENT effectiveness; MANN Whitney U Test; CHI-squared test; DESCRIPTIVE statistics; CHRONIC diseases; KAPLAN-Meier estimator; LOG-rank test; PERCUTANEOUS coronary intervention; PACLITAXEL; COMPARATIVE studies; CARDIAC arrest; CONFIDENCE intervals; DATA analysis software; DRUG-eluting stents; PROPORTIONAL hazards models; EVALUATION
- Publication
Polish Heart Journal / Kardiologia Polska, 2024, Vol 82, Issue 7/8, p749
- ISSN
0022-9032
- Publication type
Article
- DOI
10.33963/v.phj.101064