Comparison of Clinical Results Following the Use of Drug-Eluting Balloons for a Bare-Metal Stent and Drug-Eluting Stent Instent Restenosis

Background: Drug-eluting balloons (DEBs) have emerged as a potential alternative to current treatments of instent restenosis (ISR). The study aims to investigate the clinical outcomes of a DEB angioplasty to treat bare-metal stent (BMS) ISR and drug-eluting stent (DES) ISR at 1-year clinical follow-up period. Methods: Between November 2011 and December 2014, 312 patients were diagnosed with coronary artery ISR at our hospital. A total of 426 coronary ISR lesions were treated with DEBs. The clinical outcomes, including target lesion revascularization (TLR), myocardial infarction, stroke, cardiovascular mortality, and all-cause mortality were compared between the BMS-ISR group and DES-ISR group. Propensity score matched analysis was used to minimize bias. Results: The average age of the patients was 64.99 ± 10.35 years, and 76.9% of the patients were male. After multivariate Cox regression analyses about 1-year recurrent restenosis in DES-ISR group, only end stage renal disease (ESRD) (P = 0.047) and previous DEB failure (P < 0.001) were identified with significant difference. After propensity score matched analysis, the bias of baseline characteristics showed no significant difference. The DES-ISR group experienced more myocardial infarctions (2.8% vs 8.3%, P = 0.075), more TLR (8.1% vs 15.4%, P = 0.051), especially at nonostial lesion (5.7% vs 14.9%, P = 0.030) than the BMS-ISR group. Higher incidence of major cardiac cerebral adverse events happened in the DES-ISR group. (11.7% vs 22.1 %, P = 0.038). Conclusion: During the 1-year follow-up period, DEBs angioplasty for BMS-ISR had better clinical outcomes and less TLR than DES-ISR. ESRD and previous DEB failure were associated to TLR in DES-ISR group.