Impacto de stents farmacológicos em pacientes com doença arterial coronária estável submetidos a intervenção coronária percutânea na prática diária do mundo real

Abstract

Background: Recent studies in patients with stable coronary artery disease suggest there is no clinical benefit of the initial strategy of percutaneous coronary intervention with bare metal stents associated to optimal medical therapy (OMT) vs OMT alone. However, the best therapeutic option for patients with stable coronary artery disease in the real world remains controversial. We report the impact of drug eluting stents (DES) in patients with stable coronary artery disease treated in the daily clinical practice. Method: From May 2002 to November 2009, 1,814 patients with stable coronary artery disease (stable angina or silent ischemia) were prospectively included in the DESIRE Registry and 98% of the patients were followed up to 8 years (mean 3.9 ± 2 years). Results: Mean age was 64.2 ± 10.8 years, 28% had diabetes mellitus, 21% had a prior myocardial infarction and 51.7% had a prior revascularization. Left anterior descending artery was treated in 42% of the patients. When all of the lesions (n = 2,701) were taken into consideration, 66.3% were classified as complex B2/C lesions. Angiographic success was 99%. The cumulative rate of adverse events in the late clinical follow-up was: cardiac death, 3.4%; myocardial infarction, 5.5%; target-lesion revascularization (TLR), 4.8%; and stent thrombosis, 0.8%. Conclusion: The use of DES in stable coronary artery disease was associated to excellent late clinical follow-up including a cumulative TLR rate < 5% and stent thrombosis < 1%. When compared to historical data, such findings show a great benefit of DES in this