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Are drug-eluting stents indicated in large coronary arteries? Insights from a multi-centre percutaneous coronary intervention registry.
Int J Cardiol. 2008 Nov 28; 130(3):374-9.IJ

Abstract

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.

Authors+Show Affiliations

Department of Cardiology of the Royal Melbourne Hospital, Australia.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

18706719

Citation

Yan, Bryan P., et al. "Are Drug-eluting Stents Indicated in Large Coronary Arteries? Insights From a Multi-centre Percutaneous Coronary Intervention Registry." International Journal of Cardiology, vol. 130, no. 3, 2008, pp. 374-9.
Yan BP, Ajani AE, New G, et al. Are drug-eluting stents indicated in large coronary arteries? Insights from a multi-centre percutaneous coronary intervention registry. Int J Cardiol. 2008;130(3):374-9.
Yan, B. P., Ajani, A. E., New, G., Duffy, S. J., Farouque, O., Shaw, J., Sebastian, M., Lew, R., Brennan, A., Andrianopoulos, N., Reid, C., & Clark, D. J. (2008). Are drug-eluting stents indicated in large coronary arteries? Insights from a multi-centre percutaneous coronary intervention registry. International Journal of Cardiology, 130(3), 374-9. https://doi.org/10.1016/j.ijcard.2008.06.046
Yan BP, et al. Are Drug-eluting Stents Indicated in Large Coronary Arteries? Insights From a Multi-centre Percutaneous Coronary Intervention Registry. Int J Cardiol. 2008 Nov 28;130(3):374-9. PubMed PMID: 18706719.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Are drug-eluting stents indicated in large coronary arteries? Insights from a multi-centre percutaneous coronary intervention registry. AU - Yan,Bryan P, AU - Ajani,Andrew E, AU - New,Gishel, AU - Duffy,Stephen J, AU - Farouque,Omar, AU - Shaw,James, AU - Sebastian,Martin, AU - Lew,Robert, AU - Brennan,Angela, AU - Andrianopoulos,Nick, AU - Reid,Chris, AU - Clark,David J, AU - ,, Y1 - 2008/08/15/ PY - 2007/10/29/received PY - 2008/06/11/revised PY - 2008/06/28/accepted PY - 2008/8/19/pubmed PY - 2009/2/28/medline PY - 2008/8/19/entrez SP - 374 EP - 9 JF - International journal of cardiology JO - Int. J. Cardiol. VL - 130 IS - 3 N2 - 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. SN - 1874-1754 UR - https://www.unboundmedicine.com/medline/citation/18706719/Are_drug_eluting_stents_indicated_in_large_coronary_arteries_Insights_from_a_multi_centre_percutaneous_coronary_intervention_registry_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0167-5273(08)00845-0 DB - PRIME DP - Unbound Medicine ER -