Author + information
- Received January 25, 2012
- Revision received March 7, 2012
- Accepted March 16, 2012
- Published online July 1, 2012.
- Fernando Alfonso, MD⁎,⁎ (, )
- Maria J. Pérez-Vizcayno, MD⁎,
- Jaime Dutary, MD⁎,
- Javier Zueco, MD†,
- Angel Cequier, MD‡,
- Arturo García-Touchard, MD§,
- Vicens Martí, MD∥,
- Iñigo Lozano, MD¶,
- Juan Angel, MD#,
- José M. Hernández, MD⁎⁎,
- José R. López-Mínguez, MD††,
- Rafael Melgares, MD‡‡,
- Raúl Moreno, MD§§,
- Bernhard Seidelberger, MD∥∥,
- Cristina Fernández, MD⁎,
- Rosana Hernandez, MD⁎,
- RIBS-III Study Investigators (under the auspices of the Working Group on Interventional Cardiology of the Spanish Society of Cardiology)
- ↵⁎Reprint requests and correspondence:
Dr. Fernando Alfonso, Cardiología Intervencionista, Instituto Cardiovascular IdISSC, Hospital Universitario Clínico “San Carlos,” Ciudad Universitaria, Plaza de Cristo Rey, Madrid 28040, Spain
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 angiographic 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.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 25, 2012.
- Revision received March 7, 2012.
- Accepted March 16, 2012.
- American College of Cardiology Foundation