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Effectiveness of everolimus-eluting stents in the treatment of drug-eluting stent versus bare-metal stent restenosis

Almalla, Mohammad; Pross, Verena; Marx, Nikolaus; Hoffmann, Rainer

doi: 10.1097/MCA.0b013e328358a58f
Therapy and Prevention

Background The efficacy of drug-eluting stents (DES) for the treatment of in-stent restenosis (ISR) after DES implantation is not well defined. This study compared the clinical outcome after the use of everolimus-eluting stents (EES) for the treatment of bare-metal stent (BMS) versus DES restenosis.

Method Ninety-four patients with 94 ISR were included in this study. Sixty-four patients had BMS-ISR and 30 patients had DES-ISR. Patients were treated by repeat PCI using an EES. The primary endpoint of the study was survival free of target lesion revascularization (TLR) at 12 months or DES-ISR versus BMS-ISR patients. The secondary endpoints were survival free of major adverse cardiac events (MACE) and definite stent thrombosis.

Results The baseline clinical and angiographic parameters were comparable between the two groups. Treatment of DES-ISR was associated with higher rates of recurrent TLR, myocardial infarction (MI), and MACE at the 12-month follow-up compared with the treatment of BMS-ISR (23.3 versus 1.6%, P=0.002 for TLR; 13.3 versus 0%, P=0.017 for MI; and 30 versus 4.6%, P=0.003 for MACE). There were no differences in mortality and definite stent thrombosis between both groups (P=0.5686 and 0.6927, respectively). Initial stent number (odds ratio=1.13, 95% confidence interval 1.02–1.25; P=0.024) and initial stent type being a DES (odds ratio=8.11, 95% confidence interval 5.99–10.45; P<0.001) were independent predictors of recurrent TLR after the treatment of ISR using an EES.

Conclusion EES used for the treatment of DES-ISR is associated with higher rates of recurrent revascularization, MI, and MACE compared with EES for the treatment of BMS-ISR.

Department of Cardiology, Medical Clinic I, University Hospital RWTH Aachen, Aachen, Germany

Correspondence to Rainer Hoffmann, MD, Department of Cardiology, Medical Clinic I, University Hospital RWTH Aachen, Pauwelsstraße 30, 52057 Aachen, Germany Tel: +49 241 8088468; fax: +49 241 8082303; e-mail:

Received March 8, 2012

Accepted July 23, 2012

© 2012 Lippincott Williams & Wilkins, Inc.