Drug-eluting balloon angioplasty for in-stent restenosis: a systematic review and meta-analysis of randomised controlled trials

被引:80
作者
Indermuehle, Andreas [1 ]
Bahl, Rahul [1 ]
Lansky, Alexandra J. [2 ]
Froehlich, Georg M. [1 ]
Knapp, Guido [3 ]
Timmis, Adam [4 ]
Meier, Pascal [1 ,2 ]
机构
[1] Univ Coll London Hosp, Dept Cardiol, London, England
[2] Yale Univ, Sch Med, Dept Cardiol, New Haven, CT USA
[3] Tech Univ Dortmund, Dept Stat, Dortmund, Germany
[4] Chest Hosp, Dept Cardiol, London, England
关键词
PACLITAXEL-COATED BALLOON; PERCUTANEOUS CORONARY INTERVENTIONS; IMPLANTATION; PREDICTORS; MULTICENTER; PREVENTION; CATHETER; OUTCOMES;
D O I
10.1136/heartjnl-2012-302945
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context The optimal treatment option for in-stent restenosis is currently unclear. Objective Systematic review and meta-analysis of the effect of drug-eluting balloons (DEB) to treat in-stent restenosis. Data sources Trials were identified through a literature search from 2005 through 7 November 2012. Study selection Randomised clinical trials comparing DEB with a control treatment (plain balloon angioplasty or drug-eluting stents). Data extraction and synthesis Main endpoints of interest were major adverse cardiac events (MACE), target lesion revascularisation (TLR), binary in-segment restenosis, stent thrombosis (ST), myocardial infarction (MI) and mortality. A random-effects model was used to calculate the pooled relative risks (RR) with 95% CIs. Results Five studies and a total of 801 patients were included in this analysis. Follow-up duration ranged from 12 to 60months. Most endpoints were significantly reduced for DEB compared with the control groups. For MACE, the relative risk RR was 0.46 (0.31 to 0.70), p< 0.001, for TLR it was 0.34 (0.16 to 0.73); p=0.006, for angiographic in-segment restenosis it was 0.28 (0.14 to 0.58); p< 0.001. There was a lower mortality for DEB (RR 0.48 (0.24 to 0.95); p=0.034). The incidence of MI was numerically lower, but the differences were not statistically significant (RR 0.68 (0.32 to 1.48); p=0.337). There was no difference in the risk of ST (RR 1.12 (0.23 to 5.50), p=0.891). Conclusions In-stent restenosis is the bane of coronary angioplasty, and drug-eluting balloon angioplasty is a promising treatment option in this situation. It reduces the risk for MACE compared with plain balloon angioplasty or implantation of a Taxus Liberte drug-eluting stent.
引用
收藏
页码:327 / 333
页数:7
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