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Long-term outcomes of drug-eluting versus bare-metal stent implantation in patients with chronic total coronary artery occlusions.
Chin Med J (Engl). 2009 Mar 20; 122(6):643-7.CM

Abstract

BACKGROUND

There are limited data on the efficacy of drug-eluting stents (DES) for treatment of chronic total occlusions (CTO). The aim of the study was to evaluate the long-term clinical outcomes of DES implantation for CTO compared with bare-metal stent (BMS) implantation.

METHODS

Between June 1995 and December 2006, a total of 1184 patients with successful recanalization of at least one de novo CTO lesion were consecutively registered, including 660 (55.7%) who underwent DES and 524 (44.3%) who underwent BMS implantation. All patients were followed up for up to 5 years for occurrence of major adverse cardiac events (MACE). Long-term survival rates were estimated with the Kaplan-Meier method.

RESULTS

Baseline clinical and angiographic characteristics were comparable between the two groups except that patients in the DES group received longer dual antiplatelet therapy ((7.4 +/- 2.5) months vs (1.7 +/- 0.8) months, P < 0.001). Average follow-up periods were (4.7 +/- 0.89) and (3.2 +/- 1.3) years for the BMS and DES groups, respectively. There was no significant difference in 5-year survival rates between the two groups (90.3% for DES group vs 89.6% for BMS group, Log-rank P = 0.38), but the 5-year target vessel revascularization (TVR)-free survival rate in the DES group was significantly higher than that in the BMS group (81.6% vs 73.5%, Log-rank P < 0.001). The cumulative MACE-free survival in the DES group was also significantly higher than that in the BMS group (80.6% vs 71.5%, Log-rank P < 0.001). The rates of re-admission caused by cardiovascular disease (27.0% vs 37.8%, P < 0.001) and the need for bypass surgery were significantly lower in the DES group (1.5% vs 3.4%, P < 0.05). By multivariable analysis, DES implantation could significantly lower the long-term MACE risk of PCI for CTO patients (HR: 0.492; 95% CI 0.396 - 0.656, P < 0.001). Left ventricular ejection fraction < 50% and elderly (> or = 65 years) were identified as independent predictors of long-term MACE during follow-up.

CONCLUSION

This study demonstrates the long-term (up to 5 years) efficacy of DES for treatment of CTO, which is superior to BMS implantation in reducing the rates of TVR and MACE, as well as the need of re-admission and bypass surgery.

Authors+Show Affiliations

Department of Cardiology, Shenyang Northern Hospital, Shenyang, Liaoning 110016, China. hanyaling@263.netNo 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
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19323927

Citation

Han, Ya-Ling, et al. "Long-term Outcomes of Drug-eluting Versus Bare-metal Stent Implantation in Patients With Chronic Total Coronary Artery Occlusions." Chinese Medical Journal, vol. 122, no. 6, 2009, pp. 643-7.
Han YL, Zhang J, Li Y, et al. Long-term outcomes of drug-eluting versus bare-metal stent implantation in patients with chronic total coronary artery occlusions. Chin Med J. 2009;122(6):643-7.
Han, Y. L., Zhang, J., Li, Y., Wang, S. L., Jing, Q. M., Yi, X. H., Ma, Y. Y., Luan, B., Wang, G., & Wang, B. (2009). Long-term outcomes of drug-eluting versus bare-metal stent implantation in patients with chronic total coronary artery occlusions. Chinese Medical Journal, 122(6), 643-7.
Han YL, et al. Long-term Outcomes of Drug-eluting Versus Bare-metal Stent Implantation in Patients With Chronic Total Coronary Artery Occlusions. Chin Med J. 2009 Mar 20;122(6):643-7. PubMed PMID: 19323927.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term outcomes of drug-eluting versus bare-metal stent implantation in patients with chronic total coronary artery occlusions. AU - Han,Ya-Ling, AU - Zhang,Jian, AU - Li,Yi, AU - Wang,Shou-Li, AU - Jing,Quan-Min, AU - Yi,Xian-Hua, AU - Ma,Ying-Yan, AU - Luan,Bo, AU - Wang,Geng, AU - Wang,Bin, PY - 2009/3/28/entrez PY - 2009/3/28/pubmed PY - 2009/7/8/medline SP - 643 EP - 7 JF - Chinese medical journal JO - Chin. Med. J. VL - 122 IS - 6 N2 - BACKGROUND: There are limited data on the efficacy of drug-eluting stents (DES) for treatment of chronic total occlusions (CTO). The aim of the study was to evaluate the long-term clinical outcomes of DES implantation for CTO compared with bare-metal stent (BMS) implantation. METHODS: Between June 1995 and December 2006, a total of 1184 patients with successful recanalization of at least one de novo CTO lesion were consecutively registered, including 660 (55.7%) who underwent DES and 524 (44.3%) who underwent BMS implantation. All patients were followed up for up to 5 years for occurrence of major adverse cardiac events (MACE). Long-term survival rates were estimated with the Kaplan-Meier method. RESULTS: Baseline clinical and angiographic characteristics were comparable between the two groups except that patients in the DES group received longer dual antiplatelet therapy ((7.4 +/- 2.5) months vs (1.7 +/- 0.8) months, P < 0.001). Average follow-up periods were (4.7 +/- 0.89) and (3.2 +/- 1.3) years for the BMS and DES groups, respectively. There was no significant difference in 5-year survival rates between the two groups (90.3% for DES group vs 89.6% for BMS group, Log-rank P = 0.38), but the 5-year target vessel revascularization (TVR)-free survival rate in the DES group was significantly higher than that in the BMS group (81.6% vs 73.5%, Log-rank P < 0.001). The cumulative MACE-free survival in the DES group was also significantly higher than that in the BMS group (80.6% vs 71.5%, Log-rank P < 0.001). The rates of re-admission caused by cardiovascular disease (27.0% vs 37.8%, P < 0.001) and the need for bypass surgery were significantly lower in the DES group (1.5% vs 3.4%, P < 0.05). By multivariable analysis, DES implantation could significantly lower the long-term MACE risk of PCI for CTO patients (HR: 0.492; 95% CI 0.396 - 0.656, P < 0.001). Left ventricular ejection fraction < 50% and elderly (> or = 65 years) were identified as independent predictors of long-term MACE during follow-up. CONCLUSION: This study demonstrates the long-term (up to 5 years) efficacy of DES for treatment of CTO, which is superior to BMS implantation in reducing the rates of TVR and MACE, as well as the need of re-admission and bypass surgery. SN - 2542-5641 UR - https://www.unboundmedicine.com/medline/citation/19323927/Long_term_outcomes_of_drug_eluting_versus_bare_metal_stent_implantation_in_patients_with_chronic_total_coronary_artery_occlusions_ L2 - http://Insights.ovid.com/pubmed?pmid=19323927 DB - PRIME DP - Unbound Medicine ER -