OR05-3
Comparison of Drug Coated Balloon (DCB) to Drug Eluting Stent (DES) in patients with In-Stent Restenosis (ISR): A Systematic Review and Meta- Analysis of RCTs
Presenter
Manoj Kumar, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
Manoj Kumar, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, Shafaqat Ali, MD, Ochsner LSU Health Shreveport, Shreveport, LA, Nomesh Kumar, Detroit Medical Center, Detroit, MI, Mobeen Z. Haider, MBBS, Carle Foundation Hospital, Morgantown, WV, Prakash Upreti, MD, Rochester Regional Health, Rochester, NY, Abdul Rasheed Bahar, Wayne State University, Dearborn, MI, Kripa Rajak, University of Pittsburgh Medical Center,, Harrisburg , PA, Mustafa M Turkmani, McLaren Cardiovascular Institute, Rochester Hills, MI, Carson Middlebrook, Michigan State University, Detroit, MI, Salman Abdul Basit, MD, The Wright Center for GME, Scranton, PA, Khaled M. Harmouch, Detroit Medical Center, Dearborn, MI, Mohammad Hamza, Guthrie Clinic, Cortland, NY, Safia Shaikh, MD, Washington University in St Louis, Saint Louis, MO and M Chadi Alraies, MD, FSCAI, Detroit Medical Center Heart Hospital, Bloomfield , MI
Keywords: Acute Coronary Syndromes (ACS), Drug-coated Balloon (DCB) and Drug-eluting Stent (DES)
Background:
In-stent restenosis (ISR) is the gradual narrowing of the stented coronary segment, presenting as angina or leading to an acute myocardial infarction. Although the incidence has decreased with the use of newer drug-eluting stents (DES); it still carries significant mortality & morbidity. We aim to compare the two most common interventions (DCB vs DES) for the management of bare metal stent or DES-related ISR.
Methods:
Electronic databases were searched to identify all RCTs comparing Drug Coated Balloon (DCB) to DES in patients with in-stent restenosis (ISR). Mantel-Haenszel method with a random effects model was used to calculate pooled risk ratios (RR).
Results:
11 trials comprising 2,093 patients (1,087 in DCB and 1,006 in DES group) were included in the final study. Mean follow-up was 36 months. DCB was found to be equivalent to DES for management of ISR with no difference in all-cause mortality (RR: 0.82, p: 0.15), cardiac death (RR: 0.82, p: 0.27), non-cardiac death (RR: 0.86, p: 0.58), target vessel myocardial infarction (RR: 0.92, p: 0.82), myocardial infarction (RR: 0.92, p: 0.7), target lesion thrombosis (RR: 0.81, 95%, p:0.66), target lesion revascularization (TLR) (RR: 1.31, p: 0.17), target vessel revascularization (RR: 1.19, p: 0.43), and stroke (RR: 0.30, p: 0.14).
On sub-group analysis of patients with only DES-ISR, re-stenting with a DES was found to be superior to DCB, with DCB having higher TLR requirement (RR: 1.36, CI:1.06-1.75, p:0.02). Conclusions:
DCB is found to be equivalent in efficacy and safety profile to DES for management of ISR except for DES-ISR, in which DCB appears to have higher need for TLR. 