Treatment strategies for coronary in-stent restenosis: systematic review and hierarchical Bayesian network meta-analysis of 24 randomised trials and 4880 patients.

摘要: Study question What is the most safe and effective interventional treatment for coronary in-stent restenosis? Methods In a hierarchical Bayesian network meta-analysis, PubMed, Embase, Scopus, Cochrane Library, Web of Science, ScienceDirect, major scientific websites were screened up to 10 August 2015. Randomised controlled trials patients with any type restenosis (either bare metal stents or drug eluting stents; either first recurrent instances) included. Trials including multiple treatments at same time in group comparing variants intervention excluded. Primary endpoints target lesion revascularisation late lumen loss, both six 12 months. The main analysis was complemented by subanalyses, standard pairwise comparisons, subgroup sensitivity analyses. Study answer limitations Twenty four (4880 patients), seven treatments, identified. Compared plain balloons, stents, brachytherapy, rotational atherectomy, cutting coated balloons associated reduced risk adverse cardiac events, loss. Treatment ranking indicated that had highest probability (61.4%) being vascularisation; similarly as loss (probability 70.3%). comparative efficacy similar (summary odds ratio 1.10, 95% credible interval 0.59 2.01) reduction (mean difference minimum diameter 0.04 mm, −0.20 0.10). Risks death, myocardial infarction, stent thrombosis comparable across all but these analyses limited low number events. heterogeneity regarding investigation periods, baseline characteristics, endpoint reporting, lack information long term follow-up. Direct indirect evidence also inconsistent comparison between balloons. What this study adds other currently available restenosis, are superior clinical angiographic outcomes, efficacy. Funding, competing interests, data sharing This received no external funding. authors declare interests. No additional available.