[Impact of drug-eluting stents on transferring treatment with coronary surgical revascularization among patients initially admitted to department of internal medicine].
OBJECTIVE
To evaluate the impact of drug-eluting stent (DES) on transferring treatment with coronary surgical revascularization among the patients initially admitted to department of internal medicine.


METHODS
2598 patients initially admitted in department of internal medicine underwent revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) before the introduction of DES from 1 July 2001 to 30 June 2002 [bare metal stent (BMS) era group, n = 923) or after the introduction of DES from 1 July 2003 to 30 June 2004 (DES era group). The clinical manifestations and coronary angiography characteristics were analyzed retrospectively.


RESULTS
In the DES era group 1333 patients (80.1%) were revascularized with PCI, and 331 patients (19.9%) were transferred to treatment with CABG; and in the BMS era group, 721 patients (77.2%) underwent PCI, and 213 patients (22.8%) were transferred to treatment with CABG. The rate of transference to CABG of the DES era group was lower by 12.7% compared with the BMS era group. The rates of left main coronary disease, proximal left anterior descending coronary stenosis and diffuse long lesions among the patients revascularized with PCI in the DES era group were 3.2%, 44.2%, and 19.7% respectively, all significantly higher than those in the BMS era group (1.4%, 39.8%, and 11.2%, P = 0.025, P = 0.047, and = 0.021 respectively). But no matter if DES was implanted or not, left main coronary disease, proximal left anterior descending coronary stenosis, diffuse long lesions and ostial lesions were the most common coronary lesions in the patients revascularized with CABG. Logistic regression showed that number of diseased vessels, left main coronary disease, chronic total occlusion lesions, and proximal left anterior descending coronary stenosis were independent predictor for transferring treatment with CABG (all P < 0.0001).


CONCLUSIONS
DES has a certain impact on the coronary revascularization strategies, because the rate of in-stent restenosis and repeat revascularization are lower significantly after implantation of DES than after implantation of BMS. Many coronary lesions that should undergo CABG in non-DES era may be revascularized with PCI and implantation of DES.
He
Li-qun
LQ
Department of Cardiology, Beijing Anzhen Hospital, Capital University of Medical Sciences, Beijing 100029, China.
Ma
Chang-sheng
CS
Nie
Shao-ping
SP
Lü
Qiang
Q
Jia
Chang-qi
CQ
DU
Xin
X
Liu
Xiao-hui
XH
Dong
Jian-zeng
JZ
Li
Zhi-zhong
ZZ
Chen
Fang
F
Zhou
Yu-jie
YJ
Lü
Shu-zheng
SZ
Wu
Xue-si
XS
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007388:Internal Medicine; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer