Comparison of Six-Month Angiographic and Three-Year Outcomes After Sirolimus-Eluting Stent Implantation Versus Brachytherapy for Bare Metal In-Stent Restenosis

Seung Whan Lee, Seong Wook Park, Duk Woo Park, Se Whan Lee, Sang Hyun Kim, Jae Sik Jang, Yeong Hoon Jeong, Young Hak Kim, Cheol Whan Lee, Myeong Ki Hong, Seong Chul Yun, Jae Joong Kim, Seung Jung Park

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Abstract

To evaluate long-term effectiveness of sirolimus-eluting stent (SES) implantation for diffuse bare metal in-stent restenosis (ISR), we compared 6-month angiographic and long-term (3-year) clinical outcomes of SES implantation and intracoronary brachytherapy (ICBT). SES implantation for diffuse ISR was performed in 120 consecutive patients and their results were compared with those from 240 patients treated with β-radiation with balloons filled with rhenium-188 and mercaptoacetyltriglycine. The radiation dose was 15 or 18 Gy at a depth of 1.0 mm into the vessel wall. The primary end point was 3-year major adverse cardiac events including myocardial infarction, cardiac death, and target lesion revascularization. The 2 groups were similar in baseline clinical and angiographic characteristics. Lesion lengths were 25.1 ± 14.2 mm in the SES group and 24.5 ± 10.4 mm in the ICBT group (p = 0.15). In-stent acute gain was greater in the SES group than in the ICBT group (2.23 ± 0.62 vs 1.91 ± 0.54 mm, p <0.001). We obtained 6-month angiographic follow-up in 287 patients (79.7%). In-segment angiographic restenoses were 7.4% (7 of 94) in the SES group and 26.4% (51 of 193) in the ICBT group (p <0.05). Two myocardial infarctions (1 in each group) and 5 deaths (4 in SES group, 1 in ICBT group) occurred during 3-year follow-up. At 3 years, survival rates without target lesion revascularization (94.1 ± 2.2% vs 84.6 ± 2.3%, p = 0.011) and major adverse cardiac events (92.5 ± 2.4% vs 84.2 ± 2.4%, respectively, p = 0.03) were higher in the SES than in the ICBT group. In conclusion, compared with ICBT, SES implantation for diffuse ISR is more effective in decreasing recurrent restenosis and improving long-term outcomes.

Original languageEnglish
Pages (from-to)425-430
Number of pages6
JournalAmerican Journal of Cardiology
Volume100
Issue number3
DOIs
Publication statusPublished - 2007 Aug 1

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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    Lee, S. W., Park, S. W., Park, D. W., Lee, S. W., Kim, S. H., Jang, J. S., Jeong, Y. H., Kim, Y. H., Lee, C. W., Hong, M. K., Yun, S. C., Kim, J. J., & Park, S. J. (2007). Comparison of Six-Month Angiographic and Three-Year Outcomes After Sirolimus-Eluting Stent Implantation Versus Brachytherapy for Bare Metal In-Stent Restenosis. American Journal of Cardiology, 100(3), 425-430. https://doi.org/10.1016/j.amjcard.2007.03.040