Efficacy of SES for In-stent Restenosis Dependent on Original Stent Type

SAN FRANCISCO, CALIF.—The efficacy of sirolimus-eluting stents, but not paclitaxel-eluting stents, is reduced when used for the treatment of SES restenosis as compared to BMS restenosis, according to data from Germany.

“The lower absolute levels of neointimal suppression in SES-treated patients with underlying SES restenosis lends support to the hypothesis that drug resistance or hyporesponsiveness plays a role in these patients,” Robert Albert Byrne, MB, BCh, PhD, from Deutsches Herzzentrum, Munich, Germany, said during his oral abstract presentation

In the study, Byrne and colleagues pooled data from the ISAR-DESIRE and ISAR-DESIRE 2 randomized trials conducted in 2003 and 2007 to 2009, respectively. They looked at outcomes in patients treated with SES and PES for SES- or BMS-related in-stent restenosis. The primary endpoints were late loss and TLR.

Of the 650 patients included in the analysis, 325 patients were treated with SES and 325 patients were treated with PES. According to Byrne, in SES-treated patients, late loss was lower in BMS restenosis compared with SES restenosis (see Figure 1), as was TLR (11.0% vs. 20%; P=.05). Among PES-treated patients, late loss was similar for BMS restenosis compared with SES restenosis (see Figure 2), which was also true for target lesion revascularization (19% with BMS restenosis vs. 12.9% with SES restenosis; P =.15).

Byrne said these findings support the etiological relevance of drug resistance in DES restenosis.