International journal of cardiology · 2008
Are drug-eluting stents indicated in large coronary arteries? Insights from a multi-centre percutaneous coronary intervention registry.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Yan Bryan P, Ajani Andrew E, New Gishel, Duffy Stephen J, Farouque Omar, Shaw James, Sebastian Martin, Lew Robert, Brennan Angela, Andrianopoulos Nick, Reid Chris, Clark David J, Melbourne Interventional Group Investigators
Аннотация
BACKGROUND: Restenosis rates are low in large coronary vessels >/=3.5 mm after bare-metal stent (BMS) implantation. The benefit of drug-eluting stents (DES) in large vessels is not established.
OBJECTIVE: We aim to assess clinical outcomes after deployment of BMS compared to DES in patients with large coronary vessels >/=3.5 mm.
METHODS: We analysed 672 consecutive patients undergoing percutaneous coronary interventions with >/=3.5 mm stent implantation in native coronary artery de-novo lesions from the Melbourne Interventional Group (MIG) registry. Baseline characteristics, 30-day and 12-month outcomes of patients receiving BMS were compared to DES. Multivariate analysis was performed to identify predictors of major adverse cardiac events [MACE, consisting of death, myocardial infarction (MI) and target vessel revascularisation (TVR)].
RESULTS: Of the 672 PCIs performed in 844 lesions, DES was implanted in 39.5% (n=333) and BMS in 60.5% (n=511) of lesions. Patients who received DES compared to BMS were older, more likely to be diabetic, had left ventricular dysfunction <45% or complex lesions. Significantly fewer patients who presented with ST-elevation MI received DES compared to BMS. There were no significant differences in 12-month mortality (0.5 vs. 2.9%, p=0.07), TVR (3.6 vs. 4.8%, p=0.54), MI (6.3 vs. 3.4%, p=0.15), stent thrombosis (0.9 vs. 1.0%, p=0.88), or MACE (9.4 vs. 9.4%, p=0.90) in patients who received DES vs. BMS. Stent length >/=20 mm was the only independent predictor of 12-month MACE (Odds Ratio 2.07, 95% CI 1.14-3.76, p=0.02).
CONCLUSION: In this registry, BMS implantation in large native coronary vessels >/=3.5 mm was associated with a low risk of MACE and repeat revascularization at 12 months that was comparable to DES.
OBJECTIVE: We aim to assess clinical outcomes after deployment of BMS compared to DES in patients with large coronary vessels >/=3.5 mm.
METHODS: We analysed 672 consecutive patients undergoing percutaneous coronary interventions with >/=3.5 mm stent implantation in native coronary artery de-novo lesions from the Melbourne Interventional Group (MIG) registry. Baseline characteristics, 30-day and 12-month outcomes of patients receiving BMS were compared to DES. Multivariate analysis was performed to identify predictors of major adverse cardiac events [MACE, consisting of death, myocardial infarction (MI) and target vessel revascularisation (TVR)].
RESULTS: Of the 672 PCIs performed in 844 lesions, DES was implanted in 39.5% (n=333) and BMS in 60.5% (n=511) of lesions. Patients who received DES compared to BMS were older, more likely to be diabetic, had left ventricular dysfunction <45% or complex lesions. Significantly fewer patients who presented with ST-elevation MI received DES compared to BMS. There were no significant differences in 12-month mortality (0.5 vs. 2.9%, p=0.07), TVR (3.6 vs. 4.8%, p=0.54), MI (6.3 vs. 3.4%, p=0.15), stent thrombosis (0.9 vs. 1.0%, p=0.88), or MACE (9.4 vs. 9.4%, p=0.90) in patients who received DES vs. BMS. Stent length >/=20 mm was the only independent predictor of 12-month MACE (Odds Ratio 2.07, 95% CI 1.14-3.76, p=0.02).
CONCLUSION: In this registry, BMS implantation in large native coronary vessels >/=3.5 mm was associated with a low risk of MACE and repeat revascularization at 12 months that was comparable to DES.