Comparison among drug-eluting balloon, drug-eluting stent, and plain balloon angioplasty for the treatment of in-stent restenosis: A network meta-analysis of 11 randomized, controlled trials

Joo Myung Lee, Jonghanne Park, Jeehoon Kang, Ki Hyun Jeon, Ji Hyun Jung, Sang Eun Lee, Jung Kyu Han, Hack Loyung Kim, Han Mo Yang, Kyung Woo Park, Hyun Jae Kang, Bonkwon Koo, Hyo-Soo Kim

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Abstract

Objectives A Bayesian network meta-analysis was performed comparing the efficacy and safety of drug-eluting balloons (DEB), drug-eluting stents (DES), or plain old balloon angioplasty (POBA) for treatment of in-stent restenosis (ISR). Background Optimal treatment options for ISR have not been well established. Methods Randomized, controlled trials comparing DEB, DES, and POBA for the treatment of ISR after percutaneous coronary intervention with bare metal stent or DES were included. The primary outcome was target lesion revascularization (TLR). The pairwise posterior median odds ratio (OR) with 95% credible interval (CrI) was the effect measure. Results This analysis included 2,059 patients from 11 RCTs. The risk of TLR was markedly lower in patients treated with DEB (OR: 0.22, 95% CrI: 0.10 to 0.42) or DES (OR: 0.24, 95% CrI: 0.11 to 0.47) than in those treated with POBA in a random-effects model. In a comparison of DEB and DES, the risk of TLR (OR: 0.92, 95% CrI: 0.43 to 1.90) was similar. The risk of MI or all-cause mortality was lowest in the DEB group compared with the DES and POBA groups, which did not meet statistical significance. The risk of major adverse cardiac events, which was mainly driven by TLR, was also significantly lower in the DEB or and DES group (OR: 0.28, 95% CrI: 0.14 to 0.53) than in the POBA group, but it was similar between the DEB and DES groups (OR: 0.84, 95% CrI: 0.45 to 1.50). The probability of being ranked as the best treatment was 59.9% (DEB), 40.1% (DES), and 0.1% (POBA) in terms of TLR, whereas it was 63.0% (DEB), 35.3% (POBA), and 1.7% (DES) in terms of MI. Conclusions Local drug delivery by DEB or DES for ISR lesions was markedly better than POBA in preventing TLR, but not for MI or mortality. Among the 2 different strategies of drug delivery for ISR lesions, treatment with DEB showed a trend of less development of MI than did treatment with DES.

Original languageEnglish
Pages (from-to)382-394
Number of pages13
JournalJACC: Cardiovascular Interventions
Volume8
Issue number3
DOIs
StatePublished - 1 Mar 2015

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Drug-Eluting Stents
Balloon Angioplasty
Stents
Randomized Controlled Trials
Pharmaceutical Preparations
Odds Ratio
Therapeutics
Network Meta-Analysis
Mortality
Percutaneous Coronary Intervention

Keywords

  • controlled trial
  • drug-eluting balloons
  • drug-eluting stents
  • in-stent restenosis
  • meta-analysis
  • randomized

Cite this

@article{8eeb9fa38b974bad8a64d895a6c065e6,
title = "Comparison among drug-eluting balloon, drug-eluting stent, and plain balloon angioplasty for the treatment of in-stent restenosis: A network meta-analysis of 11 randomized, controlled trials",
abstract = "Objectives A Bayesian network meta-analysis was performed comparing the efficacy and safety of drug-eluting balloons (DEB), drug-eluting stents (DES), or plain old balloon angioplasty (POBA) for treatment of in-stent restenosis (ISR). Background Optimal treatment options for ISR have not been well established. Methods Randomized, controlled trials comparing DEB, DES, and POBA for the treatment of ISR after percutaneous coronary intervention with bare metal stent or DES were included. The primary outcome was target lesion revascularization (TLR). The pairwise posterior median odds ratio (OR) with 95{\%} credible interval (CrI) was the effect measure. Results This analysis included 2,059 patients from 11 RCTs. The risk of TLR was markedly lower in patients treated with DEB (OR: 0.22, 95{\%} CrI: 0.10 to 0.42) or DES (OR: 0.24, 95{\%} CrI: 0.11 to 0.47) than in those treated with POBA in a random-effects model. In a comparison of DEB and DES, the risk of TLR (OR: 0.92, 95{\%} CrI: 0.43 to 1.90) was similar. The risk of MI or all-cause mortality was lowest in the DEB group compared with the DES and POBA groups, which did not meet statistical significance. The risk of major adverse cardiac events, which was mainly driven by TLR, was also significantly lower in the DEB or and DES group (OR: 0.28, 95{\%} CrI: 0.14 to 0.53) than in the POBA group, but it was similar between the DEB and DES groups (OR: 0.84, 95{\%} CrI: 0.45 to 1.50). The probability of being ranked as the best treatment was 59.9{\%} (DEB), 40.1{\%} (DES), and 0.1{\%} (POBA) in terms of TLR, whereas it was 63.0{\%} (DEB), 35.3{\%} (POBA), and 1.7{\%} (DES) in terms of MI. Conclusions Local drug delivery by DEB or DES for ISR lesions was markedly better than POBA in preventing TLR, but not for MI or mortality. Among the 2 different strategies of drug delivery for ISR lesions, treatment with DEB showed a trend of less development of MI than did treatment with DES.",
keywords = "controlled trial, drug-eluting balloons, drug-eluting stents, in-stent restenosis, meta-analysis, randomized",
author = "Lee, {Joo Myung} and Jonghanne Park and Jeehoon Kang and Jeon, {Ki Hyun} and Jung, {Ji Hyun} and Lee, {Sang Eun} and Han, {Jung Kyu} and Kim, {Hack Loyung} and Yang, {Han Mo} and Park, {Kyung Woo} and Kang, {Hyun Jae} and Bonkwon Koo and Hyo-Soo Kim",
year = "2015",
month = "3",
day = "1",
doi = "10.1016/j.jcin.2014.09.023",
language = "English",
volume = "8",
pages = "382--394",
journal = "JACC: Cardiovascular Interventions",
issn = "1936-8798",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - Comparison among drug-eluting balloon, drug-eluting stent, and plain balloon angioplasty for the treatment of in-stent restenosis

T2 - A network meta-analysis of 11 randomized, controlled trials

AU - Lee, Joo Myung

AU - Park, Jonghanne

AU - Kang, Jeehoon

AU - Jeon, Ki Hyun

AU - Jung, Ji Hyun

AU - Lee, Sang Eun

AU - Han, Jung Kyu

AU - Kim, Hack Loyung

AU - Yang, Han Mo

AU - Park, Kyung Woo

AU - Kang, Hyun Jae

AU - Koo, Bonkwon

AU - Kim, Hyo-Soo

PY - 2015/3/1

Y1 - 2015/3/1

N2 - Objectives A Bayesian network meta-analysis was performed comparing the efficacy and safety of drug-eluting balloons (DEB), drug-eluting stents (DES), or plain old balloon angioplasty (POBA) for treatment of in-stent restenosis (ISR). Background Optimal treatment options for ISR have not been well established. Methods Randomized, controlled trials comparing DEB, DES, and POBA for the treatment of ISR after percutaneous coronary intervention with bare metal stent or DES were included. The primary outcome was target lesion revascularization (TLR). The pairwise posterior median odds ratio (OR) with 95% credible interval (CrI) was the effect measure. Results This analysis included 2,059 patients from 11 RCTs. The risk of TLR was markedly lower in patients treated with DEB (OR: 0.22, 95% CrI: 0.10 to 0.42) or DES (OR: 0.24, 95% CrI: 0.11 to 0.47) than in those treated with POBA in a random-effects model. In a comparison of DEB and DES, the risk of TLR (OR: 0.92, 95% CrI: 0.43 to 1.90) was similar. The risk of MI or all-cause mortality was lowest in the DEB group compared with the DES and POBA groups, which did not meet statistical significance. The risk of major adverse cardiac events, which was mainly driven by TLR, was also significantly lower in the DEB or and DES group (OR: 0.28, 95% CrI: 0.14 to 0.53) than in the POBA group, but it was similar between the DEB and DES groups (OR: 0.84, 95% CrI: 0.45 to 1.50). The probability of being ranked as the best treatment was 59.9% (DEB), 40.1% (DES), and 0.1% (POBA) in terms of TLR, whereas it was 63.0% (DEB), 35.3% (POBA), and 1.7% (DES) in terms of MI. Conclusions Local drug delivery by DEB or DES for ISR lesions was markedly better than POBA in preventing TLR, but not for MI or mortality. Among the 2 different strategies of drug delivery for ISR lesions, treatment with DEB showed a trend of less development of MI than did treatment with DES.

AB - Objectives A Bayesian network meta-analysis was performed comparing the efficacy and safety of drug-eluting balloons (DEB), drug-eluting stents (DES), or plain old balloon angioplasty (POBA) for treatment of in-stent restenosis (ISR). Background Optimal treatment options for ISR have not been well established. Methods Randomized, controlled trials comparing DEB, DES, and POBA for the treatment of ISR after percutaneous coronary intervention with bare metal stent or DES were included. The primary outcome was target lesion revascularization (TLR). The pairwise posterior median odds ratio (OR) with 95% credible interval (CrI) was the effect measure. Results This analysis included 2,059 patients from 11 RCTs. The risk of TLR was markedly lower in patients treated with DEB (OR: 0.22, 95% CrI: 0.10 to 0.42) or DES (OR: 0.24, 95% CrI: 0.11 to 0.47) than in those treated with POBA in a random-effects model. In a comparison of DEB and DES, the risk of TLR (OR: 0.92, 95% CrI: 0.43 to 1.90) was similar. The risk of MI or all-cause mortality was lowest in the DEB group compared with the DES and POBA groups, which did not meet statistical significance. The risk of major adverse cardiac events, which was mainly driven by TLR, was also significantly lower in the DEB or and DES group (OR: 0.28, 95% CrI: 0.14 to 0.53) than in the POBA group, but it was similar between the DEB and DES groups (OR: 0.84, 95% CrI: 0.45 to 1.50). The probability of being ranked as the best treatment was 59.9% (DEB), 40.1% (DES), and 0.1% (POBA) in terms of TLR, whereas it was 63.0% (DEB), 35.3% (POBA), and 1.7% (DES) in terms of MI. Conclusions Local drug delivery by DEB or DES for ISR lesions was markedly better than POBA in preventing TLR, but not for MI or mortality. Among the 2 different strategies of drug delivery for ISR lesions, treatment with DEB showed a trend of less development of MI than did treatment with DES.

KW - controlled trial

KW - drug-eluting balloons

KW - drug-eluting stents

KW - in-stent restenosis

KW - meta-analysis

KW - randomized

UR - http://www.scopus.com/inward/record.url?scp=84926407357&partnerID=8YFLogxK

U2 - 10.1016/j.jcin.2014.09.023

DO - 10.1016/j.jcin.2014.09.023

M3 - Article

C2 - 25703886

AN - SCOPUS:84926407357

VL - 8

SP - 382

EP - 394

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

SN - 1936-8798

IS - 3

ER -