title: The Sirolimus-eluting coronary stent in daily routine practice in Germany: trends in indications over the years. Results from the prospective multi-centre German Cypher Stent Registry.
abstract: BACKGROUND
  Drugeluting coronary stents (DES) are increasingly used during percutaneous coronary interventions (PCI). Due to limited budgets in Germany, no special reimbursement has been given for their use and therefore they were mainly used in selected patients.
  
  
  METHODS
  In order to determine the change in indications in patients treated with a Sirolimus-eluting stent (SES) in daily clinical practice between 2002 and 2005, we analysed data from a prospective multi-centre DES registry, the German Cypher Stent Registry.
  
  
  RESULTS
  From April 2002 until September 2005, 11 507 patients at 132 hospitals, who received at least one SES during their PCI, were included. Between 2002 and 2005, the median age of patients increased from 63 years to 66 years (p for trend <0.0001), whereas the prevalence of prior coronary bypass surgery (p<0.0001) and prior PCI (p<0.001) significantly decreased. Initial presentation of patients was stable over time, with a small increase of patients treated for non-ST elevation myocardial infarction (p=0.05). We found a significant increase in the treatment of complex stenoses (p<0.0001) as well as an increase in the proportion of chronic total occlusions (p<0.01). There was a steady increase in the proportion of patients treated for de novo lesions (p<0.0001), which was accompanied by a relative decrease in the proportion of patients treated for in-stent restenosis (p<0.0001). Concerning interventional characteristics a significant increase in the length of SES implanted per lesion, the numbers of SES implanted per lesion as well as an increase of the proportion of patients treated for more than one stenosis during one intervention could be observed (all p<0.0001). There was a significant decrease in the use of glycoprotein II b/IIIa antagonists during the PCI (2002: 26.5 to 14.2% in 2005, p<0.0001). MACE rates until hospital discharge did not change significantly over time.
  
  
  CONCLUSIONS
  Between 2002 and 2005 there were two trends in the use of SES: a) a significant increase in the use of SES for de novo lesions and b) a significant trend to use SES for longer lesions, smaller arteries, more complex lesions and more SES per lesion. In summary these findings indicate that still SES are mainly used in patients with lesions that are at high risk for restenosis.
authors.affiliation: Med. Klinik 8, Kardiologie/Angiologie/Internistische Intensivmedizin, Klinikum Nürnberg Süd, Breslauer Strasse 201, 90471, Nürnberg, Germany. erzahn@aol.com
authors.forename: Ralf
authors.initials: R
authors.lastname: Zahn
authors.forename: C W
authors.initials: CW
authors.lastname: Hamm
authors.forename: S
authors.initials: S
authors.lastname: Schneider
authors.forename: U
authors.initials: U
authors.lastname: Zeymer
authors.forename: G
authors.initials: G
authors.lastname: Richardt
authors.forename: M
authors.initials: M
authors.lastname: Kelm
authors.forename: B
authors.initials: B
authors.lastname: Levenson
authors.forename: T
authors.initials: T
authors.lastname: Bonzel
authors.forename: U
authors.initials: U
authors.lastname: Tebbe
authors.forename: G
authors.initials: G
authors.lastname: Sabin
authors.forename: C A
authors.initials: CA
authors.lastname: Nienaber
authors.forename: Thomas
authors.initials: T
authors.lastname: Pfannebecker
authors.forename: J
authors.initials: J
authors.lastname: Senges
mesh_terms: D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D001026:Coronary Artery Bypass; D023903:Coronary Restenosis / Q000453:epidemiology; D023921:Coronary Stenosis / Q000628:therapy; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D005858:Germany; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents / Q000639:trends*; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D020123:Sirolimus