Background： Currently, drug-eluting balloon （DEB） appears to be an attractive alternative option for the treatment of in-stent restenosis （ISR）. Nevertheless, the clinical outcomes of DEB have seldom been compare...Background： Currently, drug-eluting balloon （DEB） appears to be an attractive alternative option for the treatment of in-stent restenosis （ISR）. Nevertheless, the clinical outcomes of DEB have seldom been compared to those of new-generation drug-eluting stent （DES）. Thus, this meta-analysis aimed to evaluate the safety and efficacy of DEB compared to those of new-generation DES in the treatment of ISR. Methods： A comprehensive search of electronic databases including PubMed, EMBASE, and Cochrane Library up to November 2, 2017 was performed to identify pertinent articles comparing DEB to new-generation DES for the treatment of ISR. In addition, conference proceedings for the scientific sessions of the American College of Cardiology, American Heart Association, European Society of Cardiology, Transcatheter Cardiovascular Therapeutics, and EuroPCR were also searched. The primary endpoint was target lesion revascularization （TLR） at the longest follow-up. Dichotomous variables were presented as risk ratios （RRs） with 95% confidence intervals （C/s）, while the overall RRs were estimated using the Mantel-Haenszel random-effects model. Results： Five randomized controlled trials （RCTs） and eight observational studies involving 2743 patients were included in the present meta-analysis. Overall, DEB was comparable to new-generation DES in terms ofTLR （RR = 1.24, 95% CI： 0.89-1.72, P = 0.21 ）, cardiac death （RR = 1.55, 95% CI： 0.89-2.71, P= 0.12）, major adverse cardiovascular event （RR = 1.21,95% CI： 0.98-1.48, P = 0.07）, myocardial infarction （RR = 1.12, 95% CI： 0.72-1.76, P = 0.62）, and stent thrombosis （RR = 0.95, 95% CI： 0.38-2.42, P associated with higher risk of all-cause mortality than new-generation DES （RR = 1.65, 95% CI： 1.09-2.50, P = true in the real-world observational studies （RR = 1.79, 95% CI： 1.12-2.88, P = 0.02）. In RCTs, however, no found between the two treatment strategies in the risk of all-cause mortality. 0.92）. However, DEB was 0.02）. This was especially significant difference was Conclusions： The current meta-analysis showed that DEB and new-generation DES had comparable safety and efficacy for the treatment of ISR in RCTs. However, treatment with DEB was associated with higher risk of all-cause mortality in the real-world nonrandomized studies.展开更多
Background： High rate of in-stent restenosis （ISR） remained an unsolved clinical problem in clinical practice, especially among patients with diabetes mellitus （DM）. Diabetic patients often had hypertriglyceridem...Background： High rate of in-stent restenosis （ISR） remained an unsolved clinical problem in clinical practice, especially among patients with diabetes mellitus （DM）. Diabetic patients often had hypertriglyceridemia with elevated levels of very low-density lipoprotein cholesterol （VLDL-C）. Increasing evidence suggested that VLDL-C was known as a significant risk factor for atherosclerosis and had been recommended as a treatment target by current dyslipidemia guidelines. However, the role of VLDL-C in the occurrence and development of ISR in coronary artery disease （CAD） patients with DM had not been studied. The aim of this study was to evaluate the association between the elevated levels of VLDL-C and the risk of ISR in CAD patients with DM. Methods： A total of 1390 diabetic patients, who underwent coronary drug-eluting stent （DES） implantation at Beijing Anzhen Hospital and followed up by angiography within 6–24 months, were consecutively enrolled. Patients＇ demographic and clinical characteristics, including age, gender, CAD risk factors, family history, life style, medical history, and coronary angiographic information, were collected carefully at baseline percutaneous coronary intervention and follow-up angiography. Multivariate Cox＆#39;s proportional hazards regression modeling using the step-wise method （entry, 0.05; removal, 0.05） was used to determine the independent risk associated with ISR in diabetic patients. Results： Finally, 1206 of patients were included in this study. ISR occurred in 132/1206 diabetic patients （10.9%） by follow-up angiography. Patients with ISR had elevated median serum VLDL-C levels compared with those without ISR （0.65 mmol/L vs. 0.52 mmol/L, P = 0.030）. The multivariate regression analysis showed that VLDL-C was significantly associated with the risk of ISR in diabetic CAD patients （hazard ratio [HR] = 1.15, 95% confidence interval [CI]： 1.03–1.29, P = 0.017）. The HR for the risk of ISR associated with VLDL-C level ≥0.52 mmol/L was 3.01 （95% CI： 1.24–7.34, P = 0.015）. Conclusion： The elevated level of serum VLDL-C was a significant and independent risk factor for ISR in diabetic CAD patients after coronary DES implantation.展开更多
文摘Background： Currently, drug-eluting balloon （DEB） appears to be an attractive alternative option for the treatment of in-stent restenosis （ISR）. Nevertheless, the clinical outcomes of DEB have seldom been compared to those of new-generation drug-eluting stent （DES）. Thus, this meta-analysis aimed to evaluate the safety and efficacy of DEB compared to those of new-generation DES in the treatment of ISR. Methods： A comprehensive search of electronic databases including PubMed, EMBASE, and Cochrane Library up to November 2, 2017 was performed to identify pertinent articles comparing DEB to new-generation DES for the treatment of ISR. In addition, conference proceedings for the scientific sessions of the American College of Cardiology, American Heart Association, European Society of Cardiology, Transcatheter Cardiovascular Therapeutics, and EuroPCR were also searched. The primary endpoint was target lesion revascularization （TLR） at the longest follow-up. Dichotomous variables were presented as risk ratios （RRs） with 95% confidence intervals （C/s）, while the overall RRs were estimated using the Mantel-Haenszel random-effects model. Results： Five randomized controlled trials （RCTs） and eight observational studies involving 2743 patients were included in the present meta-analysis. Overall, DEB was comparable to new-generation DES in terms ofTLR （RR = 1.24, 95% CI： 0.89-1.72, P = 0.21 ）, cardiac death （RR = 1.55, 95% CI： 0.89-2.71, P= 0.12）, major adverse cardiovascular event （RR = 1.21,95% CI： 0.98-1.48, P = 0.07）, myocardial infarction （RR = 1.12, 95% CI： 0.72-1.76, P = 0.62）, and stent thrombosis （RR = 0.95, 95% CI： 0.38-2.42, P associated with higher risk of all-cause mortality than new-generation DES （RR = 1.65, 95% CI： 1.09-2.50, P = true in the real-world observational studies （RR = 1.79, 95% CI： 1.12-2.88, P = 0.02）. In RCTs, however, no found between the two treatment strategies in the risk of all-cause mortality. 0.92）. However, DEB was 0.02）. This was especially significant difference was Conclusions： The current meta-analysis showed that DEB and new-generation DES had comparable safety and efficacy for the treatment of ISR in RCTs. However, treatment with DEB was associated with higher risk of all-cause mortality in the real-world nonrandomized studies.
文摘Background： High rate of in-stent restenosis （ISR） remained an unsolved clinical problem in clinical practice, especially among patients with diabetes mellitus （DM）. Diabetic patients often had hypertriglyceridemia with elevated levels of very low-density lipoprotein cholesterol （VLDL-C）. Increasing evidence suggested that VLDL-C was known as a significant risk factor for atherosclerosis and had been recommended as a treatment target by current dyslipidemia guidelines. However, the role of VLDL-C in the occurrence and development of ISR in coronary artery disease （CAD） patients with DM had not been studied. The aim of this study was to evaluate the association between the elevated levels of VLDL-C and the risk of ISR in CAD patients with DM. Methods： A total of 1390 diabetic patients, who underwent coronary drug-eluting stent （DES） implantation at Beijing Anzhen Hospital and followed up by angiography within 6–24 months, were consecutively enrolled. Patients＇ demographic and clinical characteristics, including age, gender, CAD risk factors, family history, life style, medical history, and coronary angiographic information, were collected carefully at baseline percutaneous coronary intervention and follow-up angiography. Multivariate Cox＆#39;s proportional hazards regression modeling using the step-wise method （entry, 0.05; removal, 0.05） was used to determine the independent risk associated with ISR in diabetic patients. Results： Finally, 1206 of patients were included in this study. ISR occurred in 132/1206 diabetic patients （10.9%） by follow-up angiography. Patients with ISR had elevated median serum VLDL-C levels compared with those without ISR （0.65 mmol/L vs. 0.52 mmol/L, P = 0.030）. The multivariate regression analysis showed that VLDL-C was significantly associated with the risk of ISR in diabetic CAD patients （hazard ratio [HR] = 1.15, 95% confidence interval [CI]： 1.03–1.29, P = 0.017）. The HR for the risk of ISR associated with VLDL-C level ≥0.52 mmol/L was 3.01 （95% CI： 1.24–7.34, P = 0.015）. Conclusion： The elevated level of serum VLDL-C was a significant and independent risk factor for ISR in diabetic CAD patients after coronary DES implantation.
