Evolução clínica tardia dos stents farmacológicos: segurança e eficácia até cinco anos do Registro DESIRE

Abstract

Long-term Clinical Outcomes of Drug Eluting Stents. Safety and Efficacy up to Five Years of the DESIRE Registry Background: Indications for the implantation of sirolimusand paclitaxel-eluting stents are expanding and include complex lesions and subsets of patients with clinical and demographic characteristics very different from those of early pivotal randomized trials. The DESIRE Registry was planned to monitor the safety of both Cypher ® and Taxus ® stent available in Brazil since 2002. Methods and Results: From May 2002 through March 2007, 2043 patients treated with one or more than one stent (either Cypher ® or Taxus ®) at Hospital do Coração da Associação do Sanatório Sírio were included in this Registry. Mean age was 63.8 (11.3) years; 76.6% were male and 28.4% had diabetes. A total of 2,415 lesions were treated and 2,983 stents were implanted: 2,608 Cypher ® and 375 Taxus ®. Acute and subacute (≤30 days); late thrombosis (31 days-360 days) and very late thrombosis (>360 days) occurred in 0.34%, 0.73% and 0.34% of the patients, adding up to a 1.42% overall rate. Likewise, the major adverse cardiac event rate was low and added up to 8.6% (154 patients), including: 45 (2.51%) cardiac deaths; 50 (2.8%) myocardial infarctions and 59 (3.3%) of additional revascularizations. Conclusions: This long-term analysis of the DESIRE Registry shows the high efficacy and safety profiles of drug-eluting stents, with a low thrombosis rate, which is similar to those of randomized trials.

Resultados da intervenção coronária percutânea de pacientes tratados pelo sistema único de saúde e pela saúde suplementar

“…Patients with such clinical and angiographic complexities constitute the scenario where the use of DES has demonstrated its most significant benefits in terms of reducing restenosis and new interventions in relation to BMS. [10][11][12][13] In this hospital, the use of DES in approximately 20% of the patients (according to the Brazilian mean in the CENIC registry) 3 mainly includes the most complex cases. The availability of DES only in the SH justifies the difference in clinical and angiographic complexity between the groups.…”

Stents farmacológicos no tratamento da doença arterial coronária: lições do registro DESIRE

“…Trata-se do primeiro e maior registro nacional, que, hoje, conta com mais de quatro mil pacientes, acompanhados sistematicamente para a detecção de eventos após a alta hospitalar. Desde 2007, com a publicação inicial da evolução de cinco anos dos resultados globais por Sousa et al 1 , contribuiu com um total de 10 artigos originais publicados na Revista Brasileira de Cardiologia Invasiva (RBCI), que exploram os espectros clínico (diabetes, angina estável) e angiográfico (lesões on vs. off-label, vasos de fino calibre, lesões reestenóticas, enxertos de safena, bifurcações) de apresentação da doença arterial coronária. Adicionalmente, detectou preditores de revascularização do vaso-alvo e trouxe a nosso conhecimento a incidência e os preditores da trombose do stent dessa população brasileira tratada no dia a dia da prática clínica.…”

Efetividade e segurança dos stents farmacológicos em um serviço de cardiologia em Curitiba-PR

“…Sousa et al 37 analyzed in a large institutional registry from a Brazilian health service -the DESIRE study (Drug eluting stents in the real world), which included 2,043 patients receiving Taxus™ and Cypher™ stents and found cardiac event rates higher than 8.6%: repeat revascularizations in 3.3%, deaths in 2.51%, and myocardial infarction in 2.8% of the patients. These findings are quite similar to those of the literature on drug-eluting stents.…”