Predictors of death after coronary stenting with sirolimus-eluting stent in high-risk patients.
BACKGROUND
Long-term safety of drug eluting stents (DES) is under evaluation. Whether late mortality with DES may be higher than with bare metal stents is controversial and factors influencing death after DES implantation are not well known. The present observational registry analyses predictors of death during follow up after coronary stenting with sirolimus-eluting stents (SES).


METHODS
We performed an analysis of the causes of death on 233 patients included in a prospective registry that evaluated angiographic and clinical outcomes after SES implantation in complex scenarios. We analysed the relation of death with: 1) clinical, angiographic and procedural variables, and 2) clinical events, after a median follow up of 3.7 [3.4-3.9] years. We performed Cox regression analysis to assess predictors of mortality.


RESULTS
Nineteen patients (8.1%) died. Survival free of death was 91.85%. Two deaths (0.8%) were due to ictus, 2 (0.8%) were due to cancer, 2 (0.8%) were of unknown causes--not cardiac--and 13 (5.6%) were cardiac. After multivariate analysis independent predictors of death were depressed left ventricular function (HR 10.8 [3.31-35.14], p=0.0001), age (HR 1.1 [1.04-1.19], p=0.001), AMI during follow up (HR 7.03 [2.04-24.29], p=0.002), proximal LAD lesions (HR 0.15 [0.04-0.59], p=0.006), female gender (HR 3.54 [1.18-10.57], p=0.023), renal insufficiency (HR 5.82 [1.25-27.11], p=0.025) and IIb-IIIa inhibitors (HR 0.31 [0.09-1.03], p=0.054).


CONCLUSIONS
Mortality after SES implantation seems to be related to basal conditions of the patient, use of IIb-IIIa inhibitors, left ventricular dysfunction and progression of disease.
Berenguer
Alberto
A
Cardiology Service, General Hospital of Valencia, Spain. berenguer_alb@gva.es
Bordes
Pascual
P
Mainar
Vicente
V
Valencia
Jose
J
Gómez
Silvia
S
Lozano
Teresa
T
D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002423:Cause of Death; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000517:prevention & control; D018450:Disease Progression; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D017202:Myocardial Ischemia / Q000401:mortality* / Q000628:therapy*; D051437:Renal Insufficiency / Q000453:epidemiology; D018570:Risk Assessment; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology