Efficacy Of Drug-eluting Balloon With Second-generation Drug-eluting Stent For Coronary Artery In-stent Restenosis: A Meta-analysis Of Four Rcts

Objective: To investigate and evaluate the efficacy of drug-eluting balloon(DEB)and second-generation drug-eluting stent(DES)in the treatment of in-stent restenosis(ISR).Methods: According to the established search strategy,We searched Pubmed,Embase and CochraneLibrary,CNKI,Wanfang and VipuData to collect Randomized controlled trials(RCTs)regarding the treatment of ISR by DEB or second-generation DES from January 2008 to March 2017.we also manual search related journals and tracked the related references.Meta-analysis was performed using software Review Manager 5.3.RESULTS: A total of four RCTs involving 684 ISR patients were included.The follow-up time is 12 months.The results of meta-analysis showed that the incidence of TLR in DEB group was slightly higher than that in the second-generation DES group(9.9% vs 3.6%,OR = 2.91,95% CI: 1.38 ~ 6.15,p = 0.005),MACE(13.9% vs 11.0%,OR = 1.14,95% CI: 0.49 ~ 2.63,p = 0.77),all-cause mortality(3.7% vs 2.1%,OR = 1.47,95% CI: 0.54~4.04,p=0.45),cardiac death(1.5% vs 0.9%,OR = 1.51,95% CI: 0.42 ~ 5.41,p= 0.53),MI(2.7% vs 2.3%,OR = 1.12,95% % CI: 0.44 to 2.86,p = 0.81),ST(1.2% vs0.6%,OR = 0.58,95% CI: 0.41-6.10,p = 0.51),Binary restenosis(12% vs 9.0%,OR = 1.31,95% CI: 0.53 ~ 3.26,p=0.56).There were no significant difference.Conclusions: The incidence of target lesion revascularization(TLR)was significantly higher in patients with stent restenosis than in the second-generation drug-eluting stent(DES)by this meta-analysis.The incidence of major adverse cardiovascular events(MACE),all-cause mortality,heart failure,myocardial infarction(MI),stent thrombosis(ST)and binary restenosis(BAR)were not significantly different.