Drug-Eluting Balloon versus New-Generation Drug-Eluting Stent for the Treatment of In-Stent Restenosis： An Updated Systematic Review and Meta-Analysis

• Published in: Chinese medical journal 2018-03, Vol.131 (5), p.600-607
• Main Authors: Cui, Kong-Yong, Lyu, Shu-Zheng, Zhang, Min, Song, Xian-Tao, Yuan, Fei, Xu, Feng
• Format: Article
• Language: English
• Subjects: Angioplasty, Balloon, Coronary - adverse effects; Balloon angioplasty; Cardiology; Cardiovascular disease; Care and treatment; Catheters; Clinical outcomes; Comparative analysis; Coronary Restenosis - surgery; Coronary vessels; Drug-Eluting Balloon; In-Stent Restenosis; Meta-Analysis; New-Generation Drug-Eluting Stent; Drug-Eluting Stents; Heart attacks; Hospitals; Humans; Meta Analysis; Patients; Randomized Controlled Trials as Topic; Stenosis; Stents; Studies; Systematic review; Treatment Outcome; 狭窄; 评论; 系统; PubMed; DES; ISR; 会议论文; 治疗学
• ISSN: 0366-6999; 2542-5641
• DOI: 10.4103/0366-6999.226073

Background： Currently, drug-eluting balloon （DEB） appears to be an attractive alternative option for the treatment of in-stent restenosis （ISR）. Nevertheless, the clinical outcomes of DEB have seldom been compared to those of new-generation drug-eluting stent （DES）. Thus, this meta-analysis aimed to evaluate the safety and efficacy of DEB compared to those of new-generation DES in the treatment of ISR. Methods： A comprehensive search of electronic databases including PubMed, EMBASE, and Cochrane Library up to November 2, 2017 was performed to identify pertinent articles comparing DEB to new-generation DES for the treatment of ISR. In addition, conference proceedings for the scientific sessions of the American College of Cardiology, American Heart Association, European Society of Cardiology, Transcatheter Cardiovascular Therapeutics, and EuroPCR were also searched. The primary endpoint was target lesion revascularization （TLR） at the longest follow-up. Dichotomous variables were presented as risk ratios （RRs） with 95% confidence intervals （C/s）, while the overall RRs were estimated using the Mantel-Haenszel random-effects model. Results： Five randomized controlled trials （RCTs） and eight observational studies involving 2743 patients were included in the present meta-analysis. Overall, DEB was comparable to new-generation DES in terms ofTLR （RR = 1.24, 95% CI： 0.89-1.72, P = 0.21 ）, cardiac death （RR = 1.55, 95% CI： 0.89-2.71, P= 0.12）, major adverse cardiovascular event （RR = 1.21,95% CI： 0.98-1.48, P = 0.07）, myocardial infarction （RR = 1.12, 95% CI： 0.72-1.76, P = 0.62）, and stent thrombosis （RR = 0.95, 95% CI： 0.38-2.42, P associated with higher risk of all-cause mortality than new-generation DES （RR = 1.65, 95% CI： 1.09-2.50, P = true in the real-world observational studies （RR = 1.79, 95% CI： 1.12-2.88, P = 0.02）. In RCTs, however, no found between the two treatment strategies in the risk of all-cause mortality. 0.92）. However, DEB was 0.02）. This was especially significant difference was Conclusions： The current meta-analysis showed that DEB and new-generation DES had comparable safety and efficacy for the treatment of ISR in RCTs. However, treatment with DEB was associated with higher risk of all-cause mortality in the real-world nonrandomized studies.