Treatment of multivessel coronary artery disease with sirolimus-eluting stent implantation: immediate and mid-term results.
OBJECTIVE
This study evaluated clinical outcome after multivessel stenting with sirolimus-eluting stents (SES) in unselected lesions.


BACKGROUND
Safety and effectiveness of multivessel SES implantation is currently unknown.


METHODS
Major adverse cardiac events (MACE) (death, myocardial infarction [MI], and repeat revascularization) were analyzed at 30 days and at 6 months after multivessel SES implantation.


RESULTS
In 155 consecutive patients, 573 SES were implanted in 3.3 +/- 1.3 lesions per patient. At 30 days, the cumulative MACE rate was 10.3%: 7.1% patients developed a non-Q-wave MI, 1.9% developed a Q-wave MI, 0.6% died for non-cardiac reasons, and 0.6% had a repeat revascularization. Clinical follow-up was obtained in all 112 eligible patients treated for 359 lesions at a mean time of 6.5 +/- 2.2 months. The cumulative MACE rate was 22.3%: 3 (2.7%) deaths (1 for cardiac reasons), 4 (3.6%) MIs, target lesion revascularization (TLR) in 16 (14.3%) patients with 24 (6.7%) lesions. Target vessel revascularization was required in 18 (16.1%) patients due to TLR of lesions treated with SES or to disease progression (1.8% of patients). Cox regression analysis revealed total stent length per patient as the most powerful independent predictor of MACE. Overall stent thrombosis occurred in three (1.9%) patients.


CONCLUSIONS
Multivessel SES implantation can be safely performed on patients with complex coronary artery disease. The need for revascularization increases because of the cumulative effect of TLR on patients with multiple lesions.
Orlic
Dejan
D
EMO, Centro Cuore Columbus Hospital, Milan, Italy.
Bonizzoni
Erminio
E
Stankovic
Goran
G
Airoldi
Flavio
F
Chieffo
Alaide
A
Corvaja
Nicola
N
Sangiorgi
Giuseppe
G
Ferraro
Massimo
M
Briguori
Carlo
C
Montorfano
Matteo
M
Carlino
Mauro
M
Colombo
Antonio
A
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D019917:Blood Vessel Prosthesis Implantation; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D007527:Isoenzymes / Q000097:blood; D007558:Italy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D012086:Reoperation; D020123:Sirolimus / Q000627:therapeutic use*; D015607:Stents; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D016896:Treatment Outcome
D015415:Biomarkers; D020099:Coated Materials, Biocompatible; D007166:Immunosuppressive Agents; D007527:Isoenzymes; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form; D020123:Sirolimus