Document Detail


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]).
MedLine Citation:
PMID:  22814777     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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;
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Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  5     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-07-20     Completed Date:  2012-12-07     Revised Date:  2014-09-05    
Medline Journal Info:
Nlm Unique ID:  101467004     Medline TA:  JACC Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  728-37     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Angiography
Coronary Restenosis / drug therapy*,  mortality,  therapy
Coronary Vessels / pathology
Drug-Eluting Stents*
Female
Humans
Male
Risk
Spain
Investigator
Investigator/Affiliation:
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 /
Comments/Corrections
Comment In:
JACC Cardiovasc Interv. 2012 Jul;5(7):738-40   [PMID:  22814778 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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