Late outcomes after drug-eluting stent implantation in "real-world" clinical practice.
BACKGROUND
We report the late outcomes in 411 consecutive patients undergoing drug-eluting stent (DES) implantation by a single operator between 2003-2006.


METHODS
Prospective registry with continuous follow up. Patients with stable angina (SA) or acute coronary syndrome (ACS) received DES for long lesions, small vessels, chronic total occlusion, bifurcation, aorto-ostial, left main, post atherectomy or saphenous vein graft lesions, multivessel/multilesion single-vessel (V) disease, in-stent restenosis (ISR) or diabetes.


RESULTS
Age range: 34-86 years. One hundred sixty-six (40.3%) had ACS, 98.3% hypercholesterolemia and 14.6% diabetes. Two hundred sixty-one (63.5%) had percutaneous coronary intervention (PCI) to 1V and 150 (36.5%) to >1V. Six hundred seven V were treated. Two hundred fifty-nine patients (63%) had multilesion PCI, and 109 (26.5%) 1V multilesion PCI. Two hundred ninety-three (71.3%) patients had long lesions and 224 had Vs < 2.75 mm diameter. 75.5% of lesions were Type B2/C. 1-8 stents were implanted/patient. Eight hundred twenty-two of 883 stents were DES. One hundred eight patients received > or = 1 stent of < or = 2.5 mm diameter and 246 patients received stents greater than or equal to 20 mm long. Twenty-five patients developed late complications. ISR occurred in 23, 3.5-38 months after DES implantation. Three had sudden late DES thrombosis (LST). One-third also had ISR. Twenty of twenty-five required PCI, 1 CABG and 4 medical treatment. Subsequently, 3 of the 20 required further PCI for recurrent ISR and 1 CABG. 9 patients died during 1-5-year follow up.


CONCLUSIONS
In "real-world" patients at increased risk of ISR after bare-metal stenting (BMS), "off-label" DES implantation has a low incidence of late complications. The most common is ISR which presents later than after BMS. Acute LST is serious but unusual and may be accompanied by ISR.
Ramsdale
David R
DR
The Cardiothoracic Centre, Thomas Drive, Liverpool, L14 3PE, United Kingdom. David.Ramsdale@ctc.nhs.uk
Rao
Archana
A
Asghar
Omar
O
Ramsdale
Kathryn A
KA
McKay
Ewan
E
D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000601:surgery* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000188:drug therapy / Q000601:surgery* / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D001241:Aspirin / Q000627:therapeutic use; D000077144:Clopidogrel; D023903:Coronary Restenosis / Q000188:drug therapy / Q000601:surgery* / Q000628:therapy; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D012042:Registries; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin