Coronary stenting with the sirolimus-eluting stent in clinical practice: final results from the prospective multicenter German Cypher Stent Registry.
OBJECTIVE
Drug-eluting coronary stents (DES) have gained widespread use for the treatment of coronary artery disease. However, because of safety concerns and frequent "off-label" use data from "real life," registries are necessary to monitor indications and outcome of DES in daily clinical practice.


RESULTS
We evaluated data from the German Cypher Stent Registry. A total of 10,894 patients treated with at least one sirolimus-eluting stent (SES) at 152 hospitals were included. Follow-up at a median of 6.4 months was available in 10,006 patients (92%). Median age was 64.8 years and 75.5% were male. Per lesion a mean of 1.09 +/- 0.41 SES were implanted with a mean length of 21.1 +/- 11.5mm. During follow-up, death rate was 1.8% and the rates of myocardial infarction or stroke were 2.1% and 0.5%. Any target vessel revascularization (TVR) was performed in 8.0% of patients. Independent predictors for death, myocardial infarction, or stroke were: cardiogenic shock, acute coronary syndromes, reduced left ventricular function, renal insufficiency, diabetes mellitus, advanced age, three-vessel disease, degree of stenosis, and prior myocardial infarction. Predictors for a TVR were: two- or three-vessel disease, target vessel = coronary bypass, advanced age, stent diameter, ostial lesions, indication in-stent restenosis, renal failure, and target vessel = left anterior descended artery.


CONCLUSIONS
These results demonstrate that SES use in clinical practice is safe and effective. The main predictors of clinical events during follow-up are clinical parameters whereas as predictors of TVR mainly are angiographic parameters.
Zahn
Ralf
R
Herzzentrum, Kardiologie, Ludwigshafen, Germany. erzahn@aol.com
Hamm
Christian W
CW
Schneider
Steffen
S
Richardt
Gert
G
Kelm
Malte
M
Levenson
Benny
B
Bonzel
Tassilo
T
Tebbe
Ulrich
U
Sabin
Georg
G
Nienaber
Christoph A
CA
D054058:Acute Coronary Syndrome; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D016001:Confidence Intervals; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D023921:Coronary Stenosis; D003920:Diabetes Mellitus; D054855:Drug-Eluting Stents; D005260:Female; D005858:Germany; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D016017:Odds Ratio; D011446:Prospective Studies; D012372:ROC Curve; D012042:Registries; D051437:Renal Insufficiency; D012307:Risk Factors; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic; D020123:Sirolimus / Q000627:therapeutic use*; D020521:Stroke; D016896:Treatment Outcome; D016277:Ventricular Function, Left
D007166:Immunosuppressive Agents; D020123:Sirolimus