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Int J Cardiol. 2013 Oct 9;168(4):3785-90. doi: 10.1016/j.ijcard.2013.06.005. Epub 2013 Jul 2.

Long-term outcomes of drug-eluting stents versus bare-metal stents in large coronary arteries.

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  • 1Department of Cardiology and Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.

Abstract

BACKGROUND:

Long-term (>3 years) outcomes of drug-eluting stents (DES) versus bare-metal stents (BMS) in large coronary arteries were not conclusive. In addition, large coronary vessels were defined using a wide size range (≥3.0 mm) in previous studies. The aim of this study was to assess the long-term efficacy of DES versus BMS in subgroups of different vessel sizes.

METHODS:

A total of 1096 patients (1342 lesions) who underwent either DES or BMS implantation in large coronary vessels was followed for a mean duration of 4.5 years. Patients were divided into 4 subgroups by the reference vessel diameters (Q1: 3.0-3.25 mm, Q2: 3.26-3.50 mm, Q3: 3.51-3.75 mm, and Q4: 3.76-4.50 mm). The primary endpoint was major adverse cardiac events (MACE), defined as a composite of cardiac death, myocardial infarction, target vessel revascularization, and stent thrombosis. The propensity score-adjusted Cox regression method was applied.

RESULTS:

In the 3 subgroups with smaller vessel sizes, the adjusted risk of MACE in DES recipients was reduced by 82% in Q1 (hazard ratio [HR]: 0.18, 95% confidence interval [CI]: 0.09-0.38), 49% in Q2 (HR: 0.51, 95% CI: 0.26-0.98), and 67% in Q3 (HR: 0.33, 95% CI: 0.15-0.73). However, in the largest vessel subgroup (>3.75 mm), all clinical outcomes were not significantly different irrespective of the stent type used.

CONCLUSIONS:

The incidence of MACE in 3.0-3.75 mm vessels was significantly reduced by the use of DES than by the use of BMS during a long-term follow-up. However, DES lost its benefit in >3.75 mm vessels.

© 2013.

KEYWORDS:

Bare metal stent; Drug-eluting stent; Large coronary artery; Long-term outcomes

PMID:
23830345
[PubMed - indexed for MEDLINE]
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