Cobalt-chrome MULTI-LINK VISION-stent implantation in diabetics and complex lesions: results from the DaVinci-Registry.
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.
Nef
Holger M
HM
Department of Cardiology, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany. h.nef@kerckhoff-fgi.de
Möllmann
Helge
H
Weber
Michael
M
Auch-Schwelk
Wolfgang
W
Bonzel
Tassilo
T
Varelas
Joanis
J
Nordt
Thomas K
TK
Schofer
Joachim
J
Minden
Hans-Heinrich
HH
Stumpf
Jürgen
J
Schneider
Steffen
S
Elsässer
Albrecht
A
Hamm
Christian W
CW
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
D002858:Chromium Alloys
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