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

• Published in: International journal of cardiology Vol. 168; no. 4; pp. 3785 - 3790
• Main Authors: Hsieh, Ming-Jer, Chen, Chun-Chi, Chang, Shang-Hung, Wang, Chao-Yung, Lee, Cheng-Hung, Lin, Fen-Chiung, Chang, Chee-Jen, Hsieh, I-Chang
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 09.10.2013; Elsevier
• Subjects: Aged; Bare metal stent; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Coronary Vessels - pathology; Coronary Vessels - surgery; Drug-eluting stent; Drug-Eluting Stents - adverse effects; Drug-Eluting Stents - trends; Female; Follow-Up Studies; Heart; Heart Diseases - diagnosis; Heart Diseases - epidemiology; Humans; Large coronary artery; Long-term outcomes; Male; Medical sciences; Metals - adverse effects; Middle Aged; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Registries; Stents - adverse effects; Stents - trends; Time Factors; Treatment Outcome; Long-term outcomes; Large coronary artery; Bare metal stent; Drug-eluting stent; Endoprosthesis; Prognosis; Coronary artery; Instrumentation therapy; Cardiovascular disease; Metal; Long term; Evolution; Cardiology; Drug eluting stent; Comparative study
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2013.06.005

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.