title: Long-term outcomes of drug-eluting versus bare-metal stent implantation in patients with chronic total coronary artery occlusions.
abstract: BACKGROUND
  There are limited data on the efficacy of drug-eluting stents (DES) for treatment of chronic total occlusions (CTO). The aim of the study was to evaluate the long-term clinical outcomes of DES implantation for CTO compared with bare-metal stent (BMS) implantation.
  
  
  METHODS
  Between June 1995 and December 2006, a total of 1184 patients with successful recanalization of at least one de novo CTO lesion were consecutively registered, including 660 (55.7%) who underwent DES and 524 (44.3%) who underwent BMS implantation. All patients were followed up for up to 5 years for occurrence of major adverse cardiac events (MACE). Long-term survival rates were estimated with the Kaplan-Meier method.
  
  
  RESULTS
  Baseline clinical and angiographic characteristics were comparable between the two groups except that patients in the DES group received longer dual antiplatelet therapy ((7.4 +/- 2.5) months vs (1.7 +/- 0.8) months, P < 0.001). Average follow-up periods were (4.7 +/- 0.89) and (3.2 +/- 1.3) years for the BMS and DES groups, respectively. There was no significant difference in 5-year survival rates between the two groups (90.3% for DES group vs 89.6% for BMS group, Log-rank P = 0.38), but the 5-year target vessel revascularization (TVR)-free survival rate in the DES group was significantly higher than that in the BMS group (81.6% vs 73.5%, Log-rank P < 0.001). The cumulative MACE-free survival in the DES group was also significantly higher than that in the BMS group (80.6% vs 71.5%, Log-rank P < 0.001). The rates of re-admission caused by cardiovascular disease (27.0% vs 37.8%, P < 0.001) and the need for bypass surgery were significantly lower in the DES group (1.5% vs 3.4%, P < 0.05). By multivariable analysis, DES implantation could significantly lower the long-term MACE risk of PCI for CTO patients (HR: 0.492; 95% CI 0.396 - 0.656, P < 0.001). Left ventricular ejection fraction < 50% and elderly (> or = 65 years) were identified as independent predictors of long-term MACE during follow-up.
  
  
  CONCLUSIONS
  This study demonstrates the long-term (up to 5 years) efficacy of DES for treatment of CTO, which is superior to BMS implantation in reducing the rates of TVR and MACE, as well as the need of re-admission and bypass surgery.
authors.affiliation: Department of Cardiology, Shenyang Northern Hospital, Shenyang, Liaoning 110016, China. hanyaling@263.net
authors.forename: Ya-Ling
authors.initials: YL
authors.lastname: Han
authors.forename: Jian
authors.initials: J
authors.lastname: Zhang
authors.forename: Yi
authors.initials: Y
authors.lastname: Li
authors.forename: Shou-Li
authors.initials: SL
authors.lastname: Wang
authors.forename: Quan-Min
authors.initials: QM
authors.lastname: Jing
authors.forename: Xian-Hua
authors.initials: XH
authors.lastname: Yi
authors.forename: Ying-Yan
authors.initials: YY
authors.lastname: Ma
authors.forename: Bo
authors.initials: B
authors.lastname: Luan
authors.forename: Geng
authors.initials: G
authors.lastname: Wang
authors.forename: Bin
authors.initials: B
authors.lastname: Wang