Predictors of death or myocardial infarction during follow-up after coronary stenting with the sirolimus-eluting stent. Results from the prospective multicenter German Cypher Stent Registry.
BACKGROUND
Drug-eluting coronary stents are the most recent "breakthrough" technology in interventional cardiology. Whereas risk factors influencing restenosis and need for target vessel revascularization are well known, risk factors for dying or developing a myocardial infarction (MI) after drug-eluting coronary stent implantation need to be evaluated yet.


METHODS
We evaluated data from the German Cypher Stent Registry.


RESULTS
From April 2002 to December 2004, 7445 patients at 122 hospitals, who received at least one sirolimus-eluting stent during percutaneous coronary intervention, were included. Complete follow-up at a median of 6.6 months (quartiles 6.1-8.1 months) was available in 6755 patients (91%). Death occurred in 1.8% (120/6755) of patients, nonfatal MI in 2.3% (156/6635), and death or MI in 4.1% (276/6755) of patients. Independent predictors of death or MI were initial presentation with ST-elevation MI or non-ST-elevation MI (OR [odds ratio] 2.21, 95% CI 1.66-2.95, P < .0001), cardiogenic shock (OR 3.05, 95% CI 1.67-5.55, P = .0003), renal insufficiency (OR 1.74, 95% CI 1.24-2.44, P = .0017), reduced left ventricular function (OR 1.74, 95% CI 1.21-2.50, P = .0027), age (per decade) (OR 1.19, 95% CI 1.05-1.36, P = .0058), diabetes mellitus (OR 1.39, 95% CI 1.05-1.84, P = .0183), 3-vessel disease (OR 1.32, 95% CI 0.99-1.77, P = .043), and prior MI (OR 1.35, 95% CI 1.01-1.80, P = .0468), whereas interventional and lesion characteristics showed no significant association.


CONCLUSIONS
These results demonstrate that the most powerful predictors of death or MI after sirolimus-eluting stent implantation during percutaneous coronary intervention are presentation with an acute coronary syndrome, impaired left ventricular ejection fraction, and conventional risk factors for coronary heart disease. Interventional and lesion characteristics do not play a major role.
Zahn
Ralf
R
Klinikum Swfd, Kardiologie, Nürnberg, Germany. erzahn@aol.com
Hamm
Christian W
CW
Schneider
Steffen
S
Zeymer
Uwe
U
Richardt
Gert
G
Kelm
Malte
M
Levenson
Benny
B
Bonzel
Tassilo
T
Tebbe
Ulrich
U
Sabin
Georg
G
Nienaber
Christoph A
CA
Senges
Jochen
J
D000208:Acute Disease; D000368:Aged; D003327:Coronary Disease / Q000150:complications / Q000209:etiology; D023921:Coronary Stenosis / Q000150:complications / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology*; D011237:Predictive Value of Tests; D012042:Registries; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage* / Q000627:therapeutic use; D015607:Stents / Q000009:adverse effects; D013318:Stroke Volume; D013577:Syndrome
D020123:Sirolimus