Impact of drug eluting stents on the clinical practice of revascularisation of coronary artery disease.
OBJECTIVE
Drug-eluting stents (DES) have shown to reduce restenosis rates in all lesional subsets. This has expanded the application of percutaneous intervention (PCI). In this study we address the impact of the high DES penetration on the management of patients referred for coronary angiography.


RESULTS
We have studied the cohorts of patients referred for coronary angiography in 2000-2001 prior to DES availability, and in 2005-2006 with a 73% DES implementation. In 2000-1 of 2,458 coronary angiographic studies, 84% had significant lesions (>50%), 56% had PCI, 8.8% had CABG and in 443 (18%) with significant lesions no revascularisation was attempted. In 2005-6 out of 2,600 angiographies, 84% had significant lesions, 64% had PCI, 6% had CABG and in 312 (12%) with significant lesions no revascularisation was done. The increase in PCI, the reduction in CABG and the decrease in non-revascularised diseased cases were all significant (p<0,001). The PCI and CABG groups in 2005-6 compared to 2000-1 had a more complex lesion profile with, however, less in-stent restenotic lesions treated (10% vs 4.2%; p<0.001).


CONCLUSIONS
The wide clinical introduction of DES was associated with a significant increase in patients undergoing any kind of revascularisation, increasing the PCI volume to the detriment of CABG activity. Patients with PCI in 2006 had more complex lesions treated, whereas restenosis was less frequent.
de la Torre-Hernández
José M
JM
Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Marqués de Valdecilla, Santander, Spain. he1thj@humv.es
Garcia-Camarero
Tamara
T
Burgos-Palacios
Virginia
V
Ruiz-Lera
Marta
M
Llano-Cardenal
Miguel
M
Exposito
Victor
V
Sainz-Laso
Fermín
F
Lee
Dae-Hyun
DH
Figueroa
Alvaro
A
Zueco
Javier
J
D054058:Acute Coronary Syndrome / Q000401:mortality / Q000601:surgery; D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000601:surgery*; D023903:Coronary Restenosis / Q000453:epidemiology; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000706:statistics & numerical data; D019919:Prosthesis Implantation / Q000009:adverse effects*; D013997:Time Factors