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首页> 外文期刊>JACC. Cardiovascular interventions >Implantation of a drug-eluting stent with a different drug (switch strategy) in patients with drug-eluting stent restenosis: Results from a prospective multicenter study (RIBS III [restenosis intra-stent: Balloon angioplasty versus drug-eluting stent])
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Implantation of a drug-eluting stent with a different drug (switch strategy) in patients with drug-eluting stent restenosis: Results from a prospective multicenter study (RIBS III [restenosis intra-stent: Balloon angioplasty versus drug-eluting stent])

机译：在药物洗脱支架再狭窄患者中植入药物洗脱支架（切换策略）：一项前瞻性多中心研究的结果（RIBS III [支架内再狭窄：球囊血管成形术与药物洗脱支架]）

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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.
机译：目的：本研究旨在评估在支架内再狭窄（ISR）患者中使用药物洗脱支架（DES）和其他药物（开关）的策略的有效性。背景：DES ISR患者的治疗仍然是一个挑战。方法：RIBS-III（支架内再狭窄：球囊血管成形术与药物洗脱支架）研究是一项前瞻性，多中心研究，旨在评估DES ISR患者的冠状动脉介入治疗效果。建议使用其他DES。主要的血管造影终点是在9个月的随访中最小管腔直径。主要临床结果指标是心脏死亡，心肌梗塞和目标病变血运重建的综合结果。结果：这项研究包括来自西班牙12个站点的363例DES ISR连续患者。 274例患者（75％）使用了不同的DES策略，89例患者（25％）使用了替代治疗方式（无转换）。两组的基线特征相似，尽管转换组的病变长度更长。在晚期血管造影随访中（77％的合格患者，中位数：278天），最小管腔直径较大（1.86±0.7 mm对1.40±0.8 mm，p = 0.003），复发性再狭窄率较低（22％对40） ％，p = 0.008）。在最后一次临床随访中（99％的患者，中位数：771天），在不同的DES组中，合并的临床终点发生的频率较低（23％比35％，p = 0.039）。使用倾向评分分析进行调整后，再狭窄率（相对危险度：0.41，95％置信区间[CI]：0.21至0.80，p = 0.01），最小管腔直径（差异：0.41 mm，95％CI：0.19至0.62，p = 0.001），无事件生存率（危险比：0.56，95％CI：0.33至0.96，p = 0.038）仍显着改善。结论：在DES ISR患者中，与其他介入方式相比，不同DES的植入可提供更好的晚期临床和血管造影结果。

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