3-Year Follow-Up of the SISR (Sirolimus-Eluting Stents Versus Vascular Brachytherapy for In-Stent Restenosis) Trial

David Holmes, Paul S. Teirstein, Lowell Satler, Michael H. Sketch, Jeffery J. Popma, Laura Mauri, Hong (Patrick) Wang, Patricia A. Schleckser, Sidney A. Cohen

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Objectives: The aim of this study was to evaluate long-term outcome of patients treated for in-stent restenosis of bare-metal stents (BMS). Background: Treatment of restenosis of BMS is characterized by high recurrence rates. Vascular brachytherapy (VBT) improved outcome although late catch-up events were documented. Drug-eluting stents tested against VBT in this setting were found superior for at least the first year; superiority at longer follow-up is uncertain. Methods: We evaluated 3-year outcome of the multicenter SISR (Sirolimus-Eluting Stents Versus Vascular Brachytherapy for In-Stent Restenosis) trial, which randomized patients with restenosis of BMS to either a sirolimus-eluting stents (SES) or VBT. Results: Target vessel failure (cardiac death, infarction, or target vessel revascularization [TVR]) at 9 months as previously reported was significantly improved with SES. Kaplan-Meier analysis at 3 years documented that survival free from target lesion revascularization (TLR) and TVR continues to be significantly improved with SES: freedom from TLR 81.0% versus 71.6% (log-rank p = 0.018), and TVR 78.2% versus 68.8% (log-rank p = 0.022), SES versus VBT. At 3 years, target vessel failure and major adverse cardiac events (death, infarction, emergency coronary artery bypass grafting, or repeat TLR) remained improved with SES, but did not reach statistical significance. There was no statistically significant difference in definite or probable stent thrombosis (3.5% for SES, 2.4% for VBT; p = 0.758). Conclusions: At 3 years of follow-up, after treatment of in-stent restenosis of BMS, patients treated with SES have improved survival free of TLR and TVR compared with patients treated with VBT. Stent thrombosis rates are not different between the 2 groups but are higher than reported in trials of treatment of de novo lesions.

Original languageEnglish (US)
Pages (from-to)439-448
Number of pages10
JournalJACC: Cardiovascular Interventions
Volume1
Issue number4
DOIs
StatePublished - Aug 1 2008

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Brachytherapy
Sirolimus
Stents
Blood Vessels
Metals
Infarction
Thrombosis
Drug-Eluting Stents
Survival
Kaplan-Meier Estimate
Coronary Artery Bypass

Keywords

  • bare-metal stent restenosis
  • Cypher stent
  • vascular brachytherapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

3-Year Follow-Up of the SISR (Sirolimus-Eluting Stents Versus Vascular Brachytherapy for In-Stent Restenosis) Trial. / Holmes, David; Teirstein, Paul S.; Satler, Lowell; Sketch, Michael H.; Popma, Jeffery J.; Mauri, Laura; Wang, Hong (Patrick); Schleckser, Patricia A.; Cohen, Sidney A.

In: JACC: Cardiovascular Interventions, Vol. 1, No. 4, 01.08.2008, p. 439-448.

Research output: Contribution to journalArticle

Holmes, D, Teirstein, PS, Satler, L, Sketch, MH, Popma, JJ, Mauri, L, Wang, HP, Schleckser, PA & Cohen, SA 2008, '3-Year Follow-Up of the SISR (Sirolimus-Eluting Stents Versus Vascular Brachytherapy for In-Stent Restenosis) Trial', JACC: Cardiovascular Interventions, vol. 1, no. 4, pp. 439-448. https://doi.org/10.1016/j.jcin.2008.05.010
Holmes, David ; Teirstein, Paul S. ; Satler, Lowell ; Sketch, Michael H. ; Popma, Jeffery J. ; Mauri, Laura ; Wang, Hong (Patrick) ; Schleckser, Patricia A. ; Cohen, Sidney A. / 3-Year Follow-Up of the SISR (Sirolimus-Eluting Stents Versus Vascular Brachytherapy for In-Stent Restenosis) Trial. In: JACC: Cardiovascular Interventions. 2008 ; Vol. 1, No. 4. pp. 439-448.
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abstract = "Objectives: The aim of this study was to evaluate long-term outcome of patients treated for in-stent restenosis of bare-metal stents (BMS). Background: Treatment of restenosis of BMS is characterized by high recurrence rates. Vascular brachytherapy (VBT) improved outcome although late catch-up events were documented. Drug-eluting stents tested against VBT in this setting were found superior for at least the first year; superiority at longer follow-up is uncertain. Methods: We evaluated 3-year outcome of the multicenter SISR (Sirolimus-Eluting Stents Versus Vascular Brachytherapy for In-Stent Restenosis) trial, which randomized patients with restenosis of BMS to either a sirolimus-eluting stents (SES) or VBT. Results: Target vessel failure (cardiac death, infarction, or target vessel revascularization [TVR]) at 9 months as previously reported was significantly improved with SES. Kaplan-Meier analysis at 3 years documented that survival free from target lesion revascularization (TLR) and TVR continues to be significantly improved with SES: freedom from TLR 81.0{\%} versus 71.6{\%} (log-rank p = 0.018), and TVR 78.2{\%} versus 68.8{\%} (log-rank p = 0.022), SES versus VBT. At 3 years, target vessel failure and major adverse cardiac events (death, infarction, emergency coronary artery bypass grafting, or repeat TLR) remained improved with SES, but did not reach statistical significance. There was no statistically significant difference in definite or probable stent thrombosis (3.5{\%} for SES, 2.4{\%} for VBT; p = 0.758). Conclusions: At 3 years of follow-up, after treatment of in-stent restenosis of BMS, patients treated with SES have improved survival free of TLR and TVR compared with patients treated with VBT. Stent thrombosis rates are not different between the 2 groups but are higher than reported in trials of treatment of de novo lesions.",
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AU - Teirstein, Paul S.

AU - Satler, Lowell

AU - Sketch, Michael H.

AU - Popma, Jeffery J.

AU - Mauri, Laura

AU - Wang, Hong (Patrick)

AU - Schleckser, Patricia A.

AU - Cohen, Sidney A.

PY - 2008/8/1

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N2 - Objectives: The aim of this study was to evaluate long-term outcome of patients treated for in-stent restenosis of bare-metal stents (BMS). Background: Treatment of restenosis of BMS is characterized by high recurrence rates. Vascular brachytherapy (VBT) improved outcome although late catch-up events were documented. Drug-eluting stents tested against VBT in this setting were found superior for at least the first year; superiority at longer follow-up is uncertain. Methods: We evaluated 3-year outcome of the multicenter SISR (Sirolimus-Eluting Stents Versus Vascular Brachytherapy for In-Stent Restenosis) trial, which randomized patients with restenosis of BMS to either a sirolimus-eluting stents (SES) or VBT. Results: Target vessel failure (cardiac death, infarction, or target vessel revascularization [TVR]) at 9 months as previously reported was significantly improved with SES. Kaplan-Meier analysis at 3 years documented that survival free from target lesion revascularization (TLR) and TVR continues to be significantly improved with SES: freedom from TLR 81.0% versus 71.6% (log-rank p = 0.018), and TVR 78.2% versus 68.8% (log-rank p = 0.022), SES versus VBT. At 3 years, target vessel failure and major adverse cardiac events (death, infarction, emergency coronary artery bypass grafting, or repeat TLR) remained improved with SES, but did not reach statistical significance. There was no statistically significant difference in definite or probable stent thrombosis (3.5% for SES, 2.4% for VBT; p = 0.758). Conclusions: At 3 years of follow-up, after treatment of in-stent restenosis of BMS, patients treated with SES have improved survival free of TLR and TVR compared with patients treated with VBT. Stent thrombosis rates are not different between the 2 groups but are higher than reported in trials of treatment of de novo lesions.

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KW - Cypher stent

KW - vascular brachytherapy

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