Drug-eluting stents vs bare metal stents for the treatment of large coronary vessels.
BACKGROUND
Lately drug-eluting stents (DES) have dramatically reduced restenosis rates and need for repeat revascularization in a wide subset of lesion and patients. However, their benefit for the treatment of large vessels (> 3.0 mm) has yet to be established.


OBJECTIVE
We investigated whether DES are superior to bare metal stents (BMS) in terms of clinical outcomes for the treatment of large coronary vessels.


METHODS
This study assessed the long-term outcomes (cardiac death, acute myocardial infarction, and need for repeat intervention in the treated vessel) of patients treated with either a DES (Cypher and Taxus) or a BMS of > or = 3.5 mm in diameter. A total of 250 consecutive patients who underwent DES implantation were clinically followed for 1 year and compared to 250 patients who were treated with BMS. Interventions in the setting of acute ST elevation myocardial infarction and treatment of bypass grafts were excluded.


RESULTS
Cypher was the DES deployed in 70.8% of cases. Most of the enrolled patients were men (78%) with single vessel disease (65.6%). The left anterior descending artery was the culprit vessel in 34.2% of cases. Bare metal stent and DES cohorts had equivalent interpolated reference vessel diameter (3.19 +/- 0.3 mm for BMS vs 3.18 +/- 0.2 for DES; P = .1). Lesion was significantly longer in the group treated with DES (13.4 +/- 5.1 mm for BMS group vs 14.3 +/- 3.5 for DES; P = .0018). After 1 year of clinical follow-up, 95.2% of patients treated with DES and 91.2% of the patients who received BMS were free of major events (P = .2). A trend toward higher target-lesion revascularization was noticed in the group treated with BMS (4.8% vs 1.6%; P = .07).


CONCLUSIONS
Percutaneous treatment of large coronary vessels carries a low risk of clinical events irrespective of the type of stent used.
Quizhpe
Arturo R
AR
Institute Dante Pazzanese of Cardiology, São Paulo, SP, Brazil.
Feres
Fausto
F
de Ribamar Costa
José
J
Abizaid
Alexandre
A
Maldonado
Galo
G
Costa
Ricardo
R
Abizaid
Andrea
A
Cano
Manuel
M
Moreira
Adriana C
AC
Staico
Rodolfo
R
Mattos
Luiz Alberto
LA
Tanajura
Luiz Fernando
LF
Chaves
Aurea
A
Centemero
Marinella
M
Sousa
Amanda M R
AM
Sousa
J Eduardo M R
JE
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D023921:Coronary Stenosis / Q000150:complications / Q000628:therapy*; D003331:Coronary Vessels / Q000033:anatomy & histology*; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology / Q000628:therapy; D017239:Paclitaxel / Q000008:administration & dosage; D020123:Sirolimus / Q000008:administration & dosage; D015607:Stents
D007166:Immunosuppressive Agents; D017239:Paclitaxel; D020123:Sirolimus