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])

被引：82

作者：

Alfonso, Fernando ^{[1
]}

Perez-Vizcayno, Maria J. ^{[1
]}

Dutary, Jaime ^{[1
]}

Zueco, Javier ^{[2
]}

Cequier, Angel ^{[3
]}

Garcia-Touchard, Arturo ^{[4
]}

Marti, Vicens ^{[5
]}

Lozano, Inigo ^{[6
]}

Angel, Juan ^{[7
]}

Hernandez, Jose M. ^{[8
]}

Lopez-Minguez, Jose R. ^{[9
]}

Melgares, Rafael ^{[10
]}

Moreno, Raul ^{[11
]}

Seidelberger, Bernhard ^{[12
]}

Fernandez, Cristina ^{[1
]}

Hernandez, Rosana ^{[1
]}

机构：

[1] Clinico San Carlos Univ Hosp, Madrid, Spain

[2] Marques Valdecilla Univ Hosp, Santander, Spain

[3] Bellvitge Univ Hosp, Barcelona, Spain

[4] Puerta de Hierro Mahalahonda Univ Hosp, Madrid, Spain

[5] San Pablo Univ Hosp, Barcelona, Spain

[6] Cent Asturias Univ Hosp, Oviedo, Spain

[7] Valle de Hebron Univ Hosp, Barcelona, Spain

[8] Virgen de la Victoria Univ Hosp, Malaga, Spain

[9] Infanta Cristina Univ Hosp, Badajoz, Spain

[10] Virgen de las Nieves Univ Hosp, Granada, Spain

[11] La Paz Univ Hosp, Madrid, Spain

[12] La Princesa Univ Hosp, Madrid, Spain

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2012年 / 5卷 / 07期

关键词：

different stent; drug-eluting stents; in-stent restenosis; switch strategy; LONG-TERM OUTCOMES; BARE-METAL; RESISTANCE; MECHANISMS; INTERVENTION; TRIALS;

D O I：

10.1016/j.jcin.2012.03.017

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 angio-graphic 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. (J Am Coll Cardiol Intv 2012;5:728-37) (C) 2012 by the American College of Cardiology Foundation

引用

页码：728 / 737

页数：10

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