Clinical outcomes after multilesion percutaneous coronary intervention: comparison between exclusive and selective use of drug-eluting stents.
OBJECTIVE
This study compared acute and late outcomes following a strategy of selective drug-eluting stent (DES) use guided by a set of 4 criteria defining higher risk of in-stent restenosis compared to an exclusive DES strategy in 362 patients with multilesion (n = 900) percutaneous coronary interventions.


RESULTS
At a mean follow up of 412 +/- 110 days, major adverse cardiac events (death, myocardial infarction, revascularization) were 16.8% in the exclusive DES group compared to 18.4% in the selective DES group (p = 0.78). By univariate analysis, revascularization rates (9.9% in the exclusive DES group versus 10.5% in the selective DES group; p = 1.0) and target lesion revascularization (TLR) rates (5.5% versus 6.2%; p = 0.77) were similar in the 2 groups. By multivariate analysis adjusted by propensity score to account for differences in baseline characteristics, the strategy of exclusive DES use was not associated with lower risks of revascularization (hazard ratio [HR]: 0.91, 95% confidence interval [CI] 0.64-1.29) or TLR (HR: 0.81, 95% CI 0.59-1.08) compared with selective DES use. Using the Academic Research Consortium criteria, stent thrombosis occurred in 6/161 (3.7%) cases in the exclusive DES group and in 1/201 (0.5%) case in the selective DES group (p = 0.03).


CONCLUSIONS
In patients with multiple coronary lesions, a selective DES strategy for lesions at higher risk of restenosis and bare-metal stents for other lesions was safe and effective when compared to the exclusive use of DES. A large, prospective, randomized trial is required to validate a criteria-based selective DES strategy compared to systematic DES use.
Bertrand
Olivier F
OF
Department of Cardiology, Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie, affilié à l'Université Laval, 2725, Chemin Ste Foy, Québec, Canada, G1V 4G5. olivier.bertrand@crhl.ulaval.ca
Faurie
Benjamin
B
Larose
Eric
E
Nguyen
Can Manh
CM
Gleeton
Onil
O
Déry
Jean-Pierre
JP
Noël
Bernard
B
Proulx
Guy
G
Roy
Louis
L
Costerousse
Olivier
O
De Larochellière
Robert
R
Rodés-Cabau
Josep
J
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000191:economics / Q000379:methods*; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000628:therapy*; D023903:Coronary Restenosis / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D003328:Coronary Thrombosis / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010975:Platelet Aggregation Inhibitors / Q000191:economics / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011792:Quebec; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077144:Clopidogrel; D013988:Ticlopidine