Extended Outcomes of Complex Coronary Disease in the Drug Eluting Stent Era

Abstract

BackgroundSeveral randomized trials comparing bare-metal stents to Drug-Eluting Stents (DES) have demonstrated a significant reduction in Target Vessel Revascularization (TVR) and Target Lesion Revascularization (TLR) exists with the use of drug-eluting stents, without compromising survival. These conclusions are based on restricted inclusion criteria for patients and lesion. It is unknown if these results can be generalized to an unselected patient population and more complex disease. The objective of this study was to determine to what extent the availability of DES has impacted survival, TVR, and TLR in a large regional experience without the restriction of on-label indications.MethodsPatients registered with the Northern New England Cardiovascular Disease Study Group’s PCI registry with single vessel coronary disease undergoing a first PCI were sorted according to the Bare-Metal stent (BMS) era (2001 - 2002) or the Drug-Eluting stent (DES) era (2004 - 2005) based on the time period their first PCI took place. Totally, 6,093 BMS and 5,651 DES patients were identified. Outcomes of survival, TLR and TVR were measured after one year.ResultsAfter 1 year, survival was comparable, TLR was reduced by 4.9% (absolute) and TVR was reduced by 5.4% (absolute) in the DES era compared to the BMS era. The TLR/TVR differences remained significant after propensity matching in the DES era vs BMS era (Mortality: HR 1.00, 95% CI: 0.83 - 1.28; TLR: HR 0.40, 95% CI 0.32 - 0.46; TVR: HR 0.44, 95% CI 0.38 - 0.51).ConclusionsIn large regional experience with a consecutive series of patients representing the contemporary practice of PCI, including both on and off label use, the frequent use of DES reduces the risk of TVR and TLR without compromising survival.

Albumin to globulin ratio was associated with in‐stent restenosis and revascularization events after percutaneous coronary intervention

“…18 Revascularization events are another common cardiovascular event after PCI with BMS implantation or DES implantation. 19 As is known, inflammatory response and neointimal formation are major risk factors for revascularization. 20 Atherosclerosis is recognized as a chronic inflammatory disease, which is the most important pathological basis of CHD.…”

“… 18 Revascularization events are another common cardiovascular event after PCI with BMS implantation or DES implantation. 19 As is known, inflammatory response and neointimal formation are major risk factors for revascularization. 20 …”

“…ISR in patients who undergo BMS implantation usually results from intimal injury and subsequently neointimal formation, whereas ISR in DES is mainly due to inflammation 18 . Revascularization events are another common cardiovascular event after PCI with BMS implantation or DES implantation 19 . As is known, inflammatory response and neointimal formation are major risk factors for revascularization 20 …”