European Heart Journal Advance Access originally published online on June 13, 2008
European Heart Journal 2008 29(13):1625-1634; doi:10.1093/eurheartj/ehn231
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Two-year clinical outcomes after paclitaxel-eluting stent or brachytherapy treatment for bare metal stent restenosis: the TAXUS V ISR trial
1 Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, F25, Cleveland, OH 44195, USA
2 Elyria Memorial Hospital, Elyria, OH, USA
3 Nebraska Heart Institute, Lincoln, NE, USA
4 Washington Hospital Center, Washington, DC, USA
5 Oklahoma Heart Institute, Oklahoma City, OK, USA
6 Washington Adventist Hospital, Takoma Park, MD, USA
7 The Christ Hospital Heart and Vascular Center and The Lindner Research Center, Cincinnati, OH, USA
8 Caritas St Elizabeth Medical Center, Boston, MA, USA
9 Boston Scientific Corporation, Natick, MA, USA
10 The Cardiovascular Research Foundation, Columbia University Medical Center, New York, NY, USA
Received 7 November 2007; revised 26 March 2008; accepted 15 May 2008; online publish-ahead-of-print 13 June 2008.
* Corresponding author. Tel: +1 216 445 6712, Fax: +1 216 445 6714, Email: elliss{at}ccf.org
See page 1595 for the editorial comment on this article (doi:10.1093/eurheartj/ehn068)
Aims: This study sought to investigate the 2-year outcomes of patients treated with the paclitaxel-eluting TAXUS® stent (PES) or vascular brachytherapy (VBT), the previous ‘gold standard therapy’, for bare metal stent in-stent restenosis (ISR).
Methods and results: In the TAXUS V-ISR trial, 396 patients with bare metal stent ISR referred for percutaneous coronary intervention were prospectively randomized to either PES or beta source VBT. The present analysis reports 24-month clinical outcomes from that study. Between 9 and 24 months, ischaemia-driven target lesion revascularization tended to be required less frequently with assignment to PES compared to VBT (5.3 vs. 10.3%, P = .07). As a result, ischaemia-driven target lesion revascularization at 24 months was significantly reduced with PES compared with VBT (10.1 vs. 21.6%, P = 0.003), as was ischaemia-driven target vessel revascularization (18.1 vs. 27.5%, P = .03). There were no significant differences between the two groups with regard to death, myocardial infarction, or target vessel thrombosis either between 12 and 24 months, or cumulative to 24 months.
Conclusion: Freedom from clinical restenosis at 2 years is significantly enhanced after PES placement compared with VBT for bare metal stent ISR, with similar rates of death, myocardial infarction, and target vessel thrombosis.
Key Words: Drug-eluting stents • Brachytherapy • Restenosis
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