"Real life" use of sirolimus-eluting coronary stents in Germany. Results from the prospective multi-centre German Cypher Registry.
BACKGROUND
Drugeluting stents (DES) are currently judged to be a "break-through" technology for the prevention of restenosis after percutaneous coronary interventions (PCI). However, experience is limited to randomised controlled clinical trials (RCT) in selected lesions and the currently available DES are more expensive compared to conventional "bare" stents. Therefore, actual clinical practice may be very different to RCT.


METHODS
We analysed the data of the German Cypher trade mark Registry, a nationwide registry which was initiated in parallel to the launch of the first DES, the Cypher trade mark sirolimus-eluting coronary stent, in April 2002.


RESULTS
From April 2002 until March 2003, 1638 procedures at 88 hospitals were included in the German Cypher trade mark Registry. The mean inclusion rate per centre and month remained low (<3 procedures/month and participating hospital) during the whole inclusion period. Most patients presented with stable angina pectoris (45.8%); however, 6.4% of patients were treated for a non-ST elevation myocardial infarction, 10.3% of patients for ST elevation myocardial infarction and 1.7% in cardiogenic shock. In patients without ST elevation myocardial infarction, a de novo stenosis was treated in 68.4% of cases, a restenosis in 4.1%, and an in-stent restenosis in 25.5% of cases. Chronic total occlusions were treated in 6.1% of patients. Predilatation was performed in 68.3% of patients and 1.05 +/- 0.35 Cypher trade mark stents were implanted per patient with a median (quartiles) stent length of 18 (13-21) mm. PCI-related death occurred in 0.1% of patients and a Q-wave myocardial infarction in 1.1%. Urgent re-PCI before hospital discharge was performed in 1.3% and urgent bypass surgery in 0.1% of cases.


CONCLUSIONS
The use of the sirolimus-eluting coronary stents in this "real life" registry was found to be safe concerning acute complications. In about one half of the registry patients, the DES was implanted in lesions that were excluded from RCTs.
Zahn
R
R
Herzzentrum Ludwigshafen, Kardiologie, Bremserstrasse 79, 67063 Ludwigshafen, Germany. erzahn@aol.com
Hamm
C W
CW
Zeymer
U
U
Schneider
S
S
Nienaber
C A
CA
Richardt
G
G
Kelm
M
M
Levenson
B
B
Bonzel
T
T
Tebbe
U
U
Schöbel
W A
WA
Sabin
G
G
Senges
J
J
D001807:Blood Vessel Prosthesis / Q000706:statistics & numerical data*; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology* / Q000601:surgery*; D023903:Coronary Restenosis / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control*; D016503:Drug Delivery Systems / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents / Q000706:statistics & numerical data*
D020123:Sirolimus