title: Cobalt-chrome MULTI-LINK VISION-stent implantation in diabetics and complex lesions: results from the DaVinci-Registry.
abstract: OBJECTIVE
  Restenosis in bare-metal stents is in part related to stent design and material. Optimized strut design of cobalt-chrome (CoCr) stents may yield nearly comparable results to drug-eluting stents (DES) in selected lesions. The prospective multicenter DaVinci registry investigates the clinical outcome of a CoCr coronary stent (MULTI-LINK VISION), particularly in terms of patients with diabetes and complex lesions (B1, B2, C).
  
  
  RESULTS
  The prospective internet-based registry included 1,344 patients (76% males, aged 66 +/- 10 years) undergoing stent implantation (n = 1,642) in 32 centres from July 2003 to June 2004. Follow-up data (median 9 +/- 1 months) of this cohort were available for 1,289 patients (98.1%). Of these patients 327 (26.2%) were diabetics. In total, 1,429 de-novo lesions (A 11.9%, B1 47.7%, B2 31.6%, C 8.8%) were treated with the CoCr stent. The predefined primary endpoint was defined as a composite of death, Q-wave myocardial infarction (STEMI), non-STEMI (NSTEMI), target vessel revascularization (TVR) by coronary bypass graft (CABG) or PCI at 270 days (target vessel failure, TVF). Secondary endpoints include death, time to the first myocardial infarction, TVR and CABG. The cumulative incidence of major adverse cardiac events (MACE) was 12.4% with 0.8% deaths, 1.5% non-fatal MI, and 9.7% TVR. TVF in the overall cohort was documented in 137 (10.8%) patients. For diabetics and complex lesions TVF was 13.8% (95% CI 4.2-18) and 11.4% (95% CI 2.0-13.3), respectively.
  
  
  CONCLUSIONS
  This large registry confirms good acute and long-term success of CoCr stents making this strategy valuable, particularly in a special cohort (diabetics and complex lesions) as long as late stent thrombosis with DES plays a role and short-term antiplatelet therapy is favoured.
authors.affiliation: Department of Cardiology, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany. h.nef@kerckhoff-fgi.de
authors.forename: Holger M
authors.initials: HM
authors.lastname: Nef
authors.forename: Helge
authors.initials: H
authors.lastname: Möllmann
authors.forename: Michael
authors.initials: M
authors.lastname: Weber
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Auch-Schwelk
authors.forename: Tassilo
authors.initials: T
authors.lastname: Bonzel
authors.forename: Joanis
authors.initials: J
authors.lastname: Varelas
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Nordt
authors.forename: Joachim
authors.initials: J
authors.lastname: Schofer
authors.forename: Hans-Heinrich
authors.initials: HH
authors.lastname: Minden
authors.forename: Jürgen
authors.initials: J
authors.lastname: Stumpf
authors.forename: Steffen
authors.initials: S
authors.lastname: Schneider
authors.forename: Albrecht
authors.initials: A
authors.lastname: Elsässer
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
mesh_terms: D000368:Aged; D002858:Chromium Alloys; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000150:complications / Q000628:therapy*; D023903:Coronary Restenosis / Q000209:etiology*; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D015607:Stents; D016896:Treatment Outcome
chemical_list: D002858:Chromium Alloys
references.citation: N Engl J Med. 2007 Mar 8;356(10):989-97
references.pmid: 17296825
references.citation: Eur Heart J. 2004 Jun;25(11):902-19
references.pmid: 15172462
references.citation: J Am Coll Cardiol. 2002 Aug 7;40(3):403-9
references.pmid: 12142103
references.citation: N Engl J Med. 2007 Mar 8;356(10):998-1008
references.pmid: 17296824
references.citation: Clin Res Cardiol. 2007 Feb;96(2):86-93
references.pmid: 17180577
references.citation: Am J Cardiol. 2008 Jun 1;101(11):1560-6
references.pmid: 18489933
references.citation: J Am Coll Cardiol. 2008 Jun 10;51(23):2220-7
references.pmid: 18534267
references.citation: J Am Coll Cardiol. 2003 Apr 16;41(8):1283-8
references.pmid: 12706922
references.citation: Clin Res Cardiol. 2008 Jul;97(7):432-40
references.pmid: 18317669
references.citation: Circulation. 2007 Mar 20;115(11):1440-55; discussion 1455
references.pmid: 17344324
references.citation: JAMA. 2005 May 4;293(17):2126-30
references.pmid: 15870416
references.citation: Kardiol Pol. 2007 Sep;65(9):1041-6; discussion 1047-8
references.pmid: 17975751
references.citation: Circulation. 2001 Jun 12;103(23):2816-21
references.pmid: 11401938
references.citation: N Engl J Med. 2007 Mar 8;356(10):1020-9
references.pmid: 17296821
references.citation: Catheter Cardiovasc Interv. 2007 May 1;69(6):790-8
references.pmid: 17290437
references.citation: Lancet. 2000 Dec 2;356(9245):1895-7
references.pmid: 11130387
references.citation: Am J Cardiol. 1999 Dec 15;84(12):1385-90
references.pmid: 10606109
references.citation: Lancet. 2004 Oct 23-29;364(9444):1519-21
references.pmid: 15500897
references.citation: Circulation. 2007 Feb 27;115(8):1051-8
references.pmid: 17325255
references.citation: Zhonghua Xin Xue Guan Bing Za Zhi. 2006 Jun;34(6):487-91
references.pmid: 16842660
references.citation: EuroIntervention. 2005 May;1(1):58-65
references.pmid: 19758878