BACKGROUND: The expanded usage of drug-eluting stents (DES) in treating patients with multivessel coronary artery disease (CAD) may sometimes be limited in real-world practice due to cost concerns. We compared the clinical outcomes of exclusive and selective DES use in treating patients with multivessel CAD. METHODS: From November 2004 to December 2011, 110 patients with multivessel CAD who received four or more stents were enrolled into this study, and divided into two groups according to the DES strategy employed: exclusive DES (n = 52), or selective DES (n = 58). In the selective DES group, DES was reserved for complex lesions only, such that the incidence and predictors of clinical events were assessed. RESULTS: At a mean follow-up of 41.4 ± 26.5 months, there were no significant differences between the two strategies in terms of baseline characteristics, all-cause mortality (exclusive vs. selective: 1.9% vs. 6.9%, p = 0.21), cardiac death (1.9% vs. 1.7%, p = 0.94) and nonfatal myocardial infarction (3.8% vs. 5.2%, p = 0.74). Despite the presence of more ostial lesions in the exclusive DES group, there was a trend such that major adverse cardiac events (MACE) and target lesion revascularization (TLR) rates were higher in the selective DES group (MACE: 17.3% vs. 31%, p = 0.16; TLR: 11.5% vs. 24.1%, p = 0.08). The higher MACE rate in the selective DES group was mainly driven by a higher target vessel revascularization (TVR) rate (15.4% vs. 29.3%, p = 0.08). In the exclusive DES group, SYNTAX score was an independent predictor of MACE [Haxard ratio (HR): 1.09, 95% confidence internal (CI): 1.02-1.16, p = 0.01] and TVR (HR 1.08, 95% CI 1.01-1.15, p = 0.04). CONCLUSIONS: Compared to the exclusive DES strategy, the selective DES strategy with reservation of DES for complex lesions is associated with numerically higher, but not statistically significant, rates of MACE and all-cause mortality in this small group of patients with multivessel CAD receiving four or more stents. KEY WORDS: Bare metal stent; Drug-eluting stent; Multivessel coronary artery disease.
BACKGROUND: The expanded usage of drug-eluting stents (DES) in treating patients with multivessel coronary artery disease (CAD) may sometimes be limited in real-world practice due to cost concerns. We compared the clinical outcomes of exclusive and selective DES use in treating patients with multivessel CAD. METHODS: From November 2004 to December 2011, 110 patients with multivessel CAD who received four or more stents were enrolled into this study, and divided into two groups according to the DES strategy employed: exclusive DES (n = 52), or selective DES (n = 58). In the selective DES group, DES was reserved for complex lesions only, such that the incidence and predictors of clinical events were assessed. RESULTS: At a mean follow-up of 41.4 ± 26.5 months, there were no significant differences between the two strategies in terms of baseline characteristics, all-cause mortality (exclusive vs. selective: 1.9% vs. 6.9%, p = 0.21), cardiac death (1.9% vs. 1.7%, p = 0.94) and nonfatal myocardial infarction (3.8% vs. 5.2%, p = 0.74). Despite the presence of more ostial lesions in the exclusive DES group, there was a trend such that major adverse cardiac events (MACE) and target lesion revascularization (TLR) rates were higher in the selective DES group (MACE: 17.3% vs. 31%, p = 0.16; TLR: 11.5% vs. 24.1%, p = 0.08). The higher MACE rate in the selective DES group was mainly driven by a higher target vessel revascularization (TVR) rate (15.4% vs. 29.3%, p = 0.08). In the exclusive DES group, SYNTAX score was an independent predictor of MACE [Haxard ratio (HR): 1.09, 95% confidence internal (CI): 1.02-1.16, p = 0.01] and TVR (HR 1.08, 95% CI 1.01-1.15, p = 0.04). CONCLUSIONS: Compared to the exclusive DES strategy, the selective DES strategy with reservation of DES for complex lesions is associated with numerically higher, but not statistically significant, rates of MACE and all-cause mortality in this small group of patients with multivessel CAD receiving four or more stents. KEY WORDS: Bare metal stent; Drug-eluting stent; Multivessel coronary artery disease.
Authors: Marcel J B M van den Brand; Benno J W M Rensing; Marie-angèle M Morel; David P Foley; Vincent de Valk; Arno Breeman; Harry Suryapranata; Maximiliaan M P Haalebos; William Wijns; Francis Wellens; Rafael Balcon; Patrick Magee; Expedito Ribeiro; Enio Buffolo; Felix Unger; Patrick W Serruys Journal: J Am Coll Cardiol Date: 2002-02-20 Impact factor: 24.094
Authors: Asmir I Syed; Itsik Ben-Dor; Yanlin Li; Sara D Collins; Rebecca Torguson; Kohei Wakabayashi; Manuel A Gonzalez; Gabriel Maluenda; Cedric Delhaye; Loic Belle; Michael A Gaglia; Zhenyi Xue; Kimberly Kaneshige; Nelson Bernardo; Kenneth M Kent; William O Suddath; Lowell F Satler; Augusto D Pichard; Joseph Lindsay; Ron Waksman Journal: EuroIntervention Date: 2011-04 Impact factor: 6.534
Authors: Olivier F Bertrand; Benjamin Faurie; Eric Larose; Can Manh Nguyen; Onil Gleeton; Jean-Pierre Déry; Bernard Noël; Guy Proulx; Louis Roy; Olivier Costerousse; Robert De Larochellière; Josep Rodés-Cabau Journal: J Invasive Cardiol Date: 2008-03 Impact factor: 2.022
Authors: A Rodriguez; V Bernardi; J Navia; J Baldi; L Grinfeld; J Martinez; D Vogel; R Grinfeld; A Delacasa; M Garrido; R Oliveri; E Mele; I Palacios; W O'Neill Journal: J Am Coll Cardiol Date: 2001-01 Impact factor: 24.094
Authors: Stuart N Hoffman; John A TenBrook; Michael P Wolf; Stephen G Pauker; Deeb N Salem; John B Wong Journal: J Am Coll Cardiol Date: 2003-04-16 Impact factor: 24.094
Authors: Adnan Kastrati; Julinda Mehilli; Jürgen Pache; Christoph Kaiser; Marco Valgimigli; Henning Kelbaek; Maurizio Menichelli; Manel Sabaté; Maarten J Suttorp; Dietrich Baumgart; Melchior Seyfarth; Matthias E Pfisterer; Albert Schömig Journal: N Engl J Med Date: 2007-02-12 Impact factor: 91.245
Authors: Patrick W Serruys; Marie-Claude Morice; A Pieter Kappetein; Antonio Colombo; David R Holmes; Michael J Mack; Elisabeth Ståhle; Ted E Feldman; Marcel van den Brand; Eric J Bass; Nic Van Dyck; Katrin Leadley; Keith D Dawkins; Friedrich W Mohr Journal: N Engl J Med Date: 2009-02-18 Impact factor: 91.245
Authors: Christoph Stettler; Simon Wandel; Sabin Allemann; Adnan Kastrati; Marie Claude Morice; Albert Schömig; Matthias E Pfisterer; Gregg W Stone; Martin B Leon; José Suarez de Lezo; Jean-Jacques Goy; Seung-Jung Park; Manel Sabaté; Maarten J Suttorp; Henning Kelbaek; Christian Spaulding; Maurizio Menichelli; Paul Vermeersch; Maurits T Dirksen; Pavel Cervinka; Anna Sonia Petronio; Alain J Nordmann; Peter Diem; Bernhard Meier; Marcel Zwahlen; Stephan Reichenbach; Sven Trelle; Stephan Windecker; Peter Jüni Journal: Lancet Date: 2007-09-15 Impact factor: 79.321