Sirolimus-eluting stents vs vascular brachytherapy for in-stent restenosis within bare-metal stents

The SISR randomized trial

David Holmes, Paul Teirstein, Lowell Satler, Michael Sketch, James O'Malley, Jeffery J. Popma, Richard E. Kuntz, Peter J. Fitzgerald, Hong Wang, Eileen Caramanica, Sidney A. Cohen

Research output: Contribution to journalArticle

217 Citations (Scopus)

Abstract

Context: Although vascular brachytherapy is the only approved therapy for restenosis following bare-metal stent implantation, drug-eluting stents are now being used. Data on the relative merits of each are limited. Objective: To determine the safety and efficacy of the sirolimus-eluting stent compared with vascular brachytherapy for the treatment of patients with restenosis within a bare-metal stent. Design, Setting, and Patients: Prospective, multicenter, randomized trial of 384 patients with in-stent restenosis who were enrolled between February 2003 and July 2004 at 26 academic and community medical centers. Data presented represent all follow-up as of June 30, 2005. Interventions: Vascular brachytherapy (n = 125) or the sirolimus-eluting stent (n = 259). Main Outcome Measure: Target vessel failure (cardiac death, myocardial infarction, or target vessel revascularization) at 9 months postprocedure. Results: Baseline patient characteristics were well matched. Lesion length was similar between vascular brachytherapy and sirolimus-eluting stent patients (mean [SD], 16.76 [8.55] mm vs 17.22 [7.97] mm, respectively; P = .61). Procedural success was 99.2% (124/125) in the vascular brachytherapy group and 97.3% (250/257) in the sirolimus-eluting stent group (P = .28). The rate of target vessel failure was 21.6% (27/125) with vascular brachytherapy and 12.4% (32/259) with the sirolimus-eluting stent (relative risk [RR], 1.7; 95% confidence interval [CI], 1.1-2.8; P = .02). Target lesion revascularization was required in 19.2% (24/125) of the vascular brachytherapy group and 8.5% (22/259) of the sirolimus-eluting stent group (RR, 2.3 [95% CI, 1.3-3.9]; P = .004). At follow-up angiography, the rate of binary angiographic restenosis for the analysis segment was 29.5% (31/105) for the vascular brachytherapy group and 19.8% (45/227) for the sirolimus-eluting stent group (RR, 1.5 [95% CI, 1.0-2.2]; P = .07). Compared with the vascular brachytherapy group, minimal lumen diameter was larger in the sirolimus-eluting stent group at 6-month follow-up (mean [SD], 1.52 [0.63] mm vs 1.80 [0.63] mm; P < .001), reflecting greater net lumen gain in the analysis segment (0.68 [0.60] vs 1.0 [0.61] mm; P < .001) due to stenting and no edge restenosis. Conclusion: Sirolimus-eluting stents result in superior clinical and angiographic outcomes compared with vascular brachytherapy for the treatment of restenosis within a bare-metal stent. Trial Registration: ClinicalTrials.gov Identifier: NCT00231257.

Original languageEnglish (US)
Pages (from-to)1264-1273
Number of pages10
JournalJournal of the American Medical Association
Volume295
Issue number11
DOIs
StatePublished - Mar 15 2006

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Brachytherapy
Sirolimus
Stents
Blood Vessels
Metals
Confidence Intervals
Drug-Eluting Stents
Multicenter Studies
Angiography
Therapeutics
Myocardial Infarction
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Sirolimus-eluting stents vs vascular brachytherapy for in-stent restenosis within bare-metal stents : The SISR randomized trial. / Holmes, David; Teirstein, Paul; Satler, Lowell; Sketch, Michael; O'Malley, James; Popma, Jeffery J.; Kuntz, Richard E.; Fitzgerald, Peter J.; Wang, Hong; Caramanica, Eileen; Cohen, Sidney A.

In: Journal of the American Medical Association, Vol. 295, No. 11, 15.03.2006, p. 1264-1273.

Research output: Contribution to journalArticle

Holmes, D, Teirstein, P, Satler, L, Sketch, M, O'Malley, J, Popma, JJ, Kuntz, RE, Fitzgerald, PJ, Wang, H, Caramanica, E & Cohen, SA 2006, 'Sirolimus-eluting stents vs vascular brachytherapy for in-stent restenosis within bare-metal stents: The SISR randomized trial', Journal of the American Medical Association, vol. 295, no. 11, pp. 1264-1273. https://doi.org/10.1001/jama.295.11.1264
Holmes, David ; Teirstein, Paul ; Satler, Lowell ; Sketch, Michael ; O'Malley, James ; Popma, Jeffery J. ; Kuntz, Richard E. ; Fitzgerald, Peter J. ; Wang, Hong ; Caramanica, Eileen ; Cohen, Sidney A. / Sirolimus-eluting stents vs vascular brachytherapy for in-stent restenosis within bare-metal stents : The SISR randomized trial. In: Journal of the American Medical Association. 2006 ; Vol. 295, No. 11. pp. 1264-1273.
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abstract = "Context: Although vascular brachytherapy is the only approved therapy for restenosis following bare-metal stent implantation, drug-eluting stents are now being used. Data on the relative merits of each are limited. Objective: To determine the safety and efficacy of the sirolimus-eluting stent compared with vascular brachytherapy for the treatment of patients with restenosis within a bare-metal stent. Design, Setting, and Patients: Prospective, multicenter, randomized trial of 384 patients with in-stent restenosis who were enrolled between February 2003 and July 2004 at 26 academic and community medical centers. Data presented represent all follow-up as of June 30, 2005. Interventions: Vascular brachytherapy (n = 125) or the sirolimus-eluting stent (n = 259). Main Outcome Measure: Target vessel failure (cardiac death, myocardial infarction, or target vessel revascularization) at 9 months postprocedure. Results: Baseline patient characteristics were well matched. Lesion length was similar between vascular brachytherapy and sirolimus-eluting stent patients (mean [SD], 16.76 [8.55] mm vs 17.22 [7.97] mm, respectively; P = .61). Procedural success was 99.2{\%} (124/125) in the vascular brachytherapy group and 97.3{\%} (250/257) in the sirolimus-eluting stent group (P = .28). The rate of target vessel failure was 21.6{\%} (27/125) with vascular brachytherapy and 12.4{\%} (32/259) with the sirolimus-eluting stent (relative risk [RR], 1.7; 95{\%} confidence interval [CI], 1.1-2.8; P = .02). Target lesion revascularization was required in 19.2{\%} (24/125) of the vascular brachytherapy group and 8.5{\%} (22/259) of the sirolimus-eluting stent group (RR, 2.3 [95{\%} CI, 1.3-3.9]; P = .004). At follow-up angiography, the rate of binary angiographic restenosis for the analysis segment was 29.5{\%} (31/105) for the vascular brachytherapy group and 19.8{\%} (45/227) for the sirolimus-eluting stent group (RR, 1.5 [95{\%} CI, 1.0-2.2]; P = .07). Compared with the vascular brachytherapy group, minimal lumen diameter was larger in the sirolimus-eluting stent group at 6-month follow-up (mean [SD], 1.52 [0.63] mm vs 1.80 [0.63] mm; P < .001), reflecting greater net lumen gain in the analysis segment (0.68 [0.60] vs 1.0 [0.61] mm; P < .001) due to stenting and no edge restenosis. Conclusion: Sirolimus-eluting stents result in superior clinical and angiographic outcomes compared with vascular brachytherapy for the treatment of restenosis within a bare-metal stent. Trial Registration: ClinicalTrials.gov Identifier: NCT00231257.",
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TY - JOUR

T1 - Sirolimus-eluting stents vs vascular brachytherapy for in-stent restenosis within bare-metal stents

T2 - The SISR randomized trial

AU - Holmes, David

AU - Teirstein, Paul

AU - Satler, Lowell

AU - Sketch, Michael

AU - O'Malley, James

AU - Popma, Jeffery J.

AU - Kuntz, Richard E.

AU - Fitzgerald, Peter J.

AU - Wang, Hong

AU - Caramanica, Eileen

AU - Cohen, Sidney A.

PY - 2006/3/15

Y1 - 2006/3/15

N2 - Context: Although vascular brachytherapy is the only approved therapy for restenosis following bare-metal stent implantation, drug-eluting stents are now being used. Data on the relative merits of each are limited. Objective: To determine the safety and efficacy of the sirolimus-eluting stent compared with vascular brachytherapy for the treatment of patients with restenosis within a bare-metal stent. Design, Setting, and Patients: Prospective, multicenter, randomized trial of 384 patients with in-stent restenosis who were enrolled between February 2003 and July 2004 at 26 academic and community medical centers. Data presented represent all follow-up as of June 30, 2005. Interventions: Vascular brachytherapy (n = 125) or the sirolimus-eluting stent (n = 259). Main Outcome Measure: Target vessel failure (cardiac death, myocardial infarction, or target vessel revascularization) at 9 months postprocedure. Results: Baseline patient characteristics were well matched. Lesion length was similar between vascular brachytherapy and sirolimus-eluting stent patients (mean [SD], 16.76 [8.55] mm vs 17.22 [7.97] mm, respectively; P = .61). Procedural success was 99.2% (124/125) in the vascular brachytherapy group and 97.3% (250/257) in the sirolimus-eluting stent group (P = .28). The rate of target vessel failure was 21.6% (27/125) with vascular brachytherapy and 12.4% (32/259) with the sirolimus-eluting stent (relative risk [RR], 1.7; 95% confidence interval [CI], 1.1-2.8; P = .02). Target lesion revascularization was required in 19.2% (24/125) of the vascular brachytherapy group and 8.5% (22/259) of the sirolimus-eluting stent group (RR, 2.3 [95% CI, 1.3-3.9]; P = .004). At follow-up angiography, the rate of binary angiographic restenosis for the analysis segment was 29.5% (31/105) for the vascular brachytherapy group and 19.8% (45/227) for the sirolimus-eluting stent group (RR, 1.5 [95% CI, 1.0-2.2]; P = .07). Compared with the vascular brachytherapy group, minimal lumen diameter was larger in the sirolimus-eluting stent group at 6-month follow-up (mean [SD], 1.52 [0.63] mm vs 1.80 [0.63] mm; P < .001), reflecting greater net lumen gain in the analysis segment (0.68 [0.60] vs 1.0 [0.61] mm; P < .001) due to stenting and no edge restenosis. Conclusion: Sirolimus-eluting stents result in superior clinical and angiographic outcomes compared with vascular brachytherapy for the treatment of restenosis within a bare-metal stent. Trial Registration: ClinicalTrials.gov Identifier: NCT00231257.

AB - Context: Although vascular brachytherapy is the only approved therapy for restenosis following bare-metal stent implantation, drug-eluting stents are now being used. Data on the relative merits of each are limited. Objective: To determine the safety and efficacy of the sirolimus-eluting stent compared with vascular brachytherapy for the treatment of patients with restenosis within a bare-metal stent. Design, Setting, and Patients: Prospective, multicenter, randomized trial of 384 patients with in-stent restenosis who were enrolled between February 2003 and July 2004 at 26 academic and community medical centers. Data presented represent all follow-up as of June 30, 2005. Interventions: Vascular brachytherapy (n = 125) or the sirolimus-eluting stent (n = 259). Main Outcome Measure: Target vessel failure (cardiac death, myocardial infarction, or target vessel revascularization) at 9 months postprocedure. Results: Baseline patient characteristics were well matched. Lesion length was similar between vascular brachytherapy and sirolimus-eluting stent patients (mean [SD], 16.76 [8.55] mm vs 17.22 [7.97] mm, respectively; P = .61). Procedural success was 99.2% (124/125) in the vascular brachytherapy group and 97.3% (250/257) in the sirolimus-eluting stent group (P = .28). The rate of target vessel failure was 21.6% (27/125) with vascular brachytherapy and 12.4% (32/259) with the sirolimus-eluting stent (relative risk [RR], 1.7; 95% confidence interval [CI], 1.1-2.8; P = .02). Target lesion revascularization was required in 19.2% (24/125) of the vascular brachytherapy group and 8.5% (22/259) of the sirolimus-eluting stent group (RR, 2.3 [95% CI, 1.3-3.9]; P = .004). At follow-up angiography, the rate of binary angiographic restenosis for the analysis segment was 29.5% (31/105) for the vascular brachytherapy group and 19.8% (45/227) for the sirolimus-eluting stent group (RR, 1.5 [95% CI, 1.0-2.2]; P = .07). Compared with the vascular brachytherapy group, minimal lumen diameter was larger in the sirolimus-eluting stent group at 6-month follow-up (mean [SD], 1.52 [0.63] mm vs 1.80 [0.63] mm; P < .001), reflecting greater net lumen gain in the analysis segment (0.68 [0.60] vs 1.0 [0.61] mm; P < .001) due to stenting and no edge restenosis. Conclusion: Sirolimus-eluting stents result in superior clinical and angiographic outcomes compared with vascular brachytherapy for the treatment of restenosis within a bare-metal stent. Trial Registration: ClinicalTrials.gov Identifier: NCT00231257.

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