Clinical and angiographic follow-up after coronary drug-eluting and bare metal stent implantation. Do drug-eluting stents hold the promise?
OBJECTIVE
To investigate the influence of drug-eluting stent (DES) implantation on clinical and angiographic restenosis.


METHODS
Registry study of data from the Swedish Coronary Angiography and Angioplasty Registry with a coronary angiographic substudy.


METHODS
Multi-centre study.


METHODS
During October 2002 to May 2004 a total of 23 590 percutaneous coronary intervention (PCI) procedures were performed at 25 hospitals. After selection, to achieve comparable groups, a total of 5068 patients of whom 4111 had a bare metal stent (BMS) implanted and 957 had a DES implanted, remained. End-point in the registry follow-up was >50% diameter restenosis at clinically driven reangiography within 12 months after index PCI. The primary end-point in the angiographic substudy was late loss in patients' DES at 6-month angiographic follow-up.


RESULTS
The rate of clinically driven restenosis, within 12 months, in patients receiving DES was less (3.9%) compared with those who received BMS (7.0%). In multivariate analysis the risk of clinical restenosis was one-third for DES compared with BMS (HR 0.36, 95% CI 0.25-0.52). In the angiographic substudy late loss was 0.07+/-0.53 mm (range -0.88 to 1.62). The amount of late loss was related to the presence of diabetes mellitus or not (0.19+/-0.45 mm vs. -0.12+/-0.58 mm), and lack of postdilatation of the stent or not (0.23+/-0.51 mm vs. -0.09+/-0.50 mm).


CONCLUSIONS
The use of DES in the Swedish 'real world' is effective in reducing the clinically driven restenosis rate, when compared with patients with BMS treatment. In the angiographic follow-up the average late loss was as low as observed in recent randomized multi-centre trials.
Jensen
J
J
Department of Cardiology, Karolinska University Hospital, Solna, Stockholm, Sweden. jens.jensen@karolinska.se
Lagerqvist
B
B
Aasa
M
M
Särev
T
T
Nilsson
T
T
Tornvall
P
P
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000517:prevention & control; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D003692:Delayed-Action Preparations; D018572:Disease-Free Survival; D004343:Drug Implants; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008670:Metals; D008875:Middle Aged; D015999:Multivariate Analysis; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods; D012042:Registries; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents; D013548:Sweden
D003692:Delayed-Action Preparations; D004343:Drug Implants; D007166:Immunosuppressive Agents; D008670:Metals; D020123:Sirolimus