Repeat coronary revascularization procedures after successful bare-metal or drug-eluting stent implantation.
BACKGROUND
The goal of this study was to assess the rate and anatomical targets of repeat revascularization procedures in routine clinical practice after either bare-metal stent (BMS) or drug-eluting stent (DES) implantation. Randomized trials provide a reference standard for comparing outcomes after BMS or DES, but the rates of repeat revascularization procedures in clinical trials do not necessarily represent the rates in routine practice.


METHODS
Baseline and 1-year follow-up angiographic data from a cardiac catheterization laboratory data registry with 31 participating hospitals were analyzed.


RESULTS
In 17 hospitals 14,459 eligible patients had a BMS implanted between 1998 and 2003, and in 20 hospitals 9,575 eligible patients had a DES implanted in 2005. DES patients had more multivessel disease and diabetes than BMS patients, but fewer DES patients had all diseased vessels stented. Over the subsequent year, there were significantly fewer repeat procedures in the initially stented region after DES than BMS (4.7% vs. 8.1%), but significantly more procedures in previously unstented remote segments (7.8% vs. 4.3%). Consequently, the overall rate of additional percutaneous coronary intervention admissions was not reduced by DES (12.5% vs. 12.3%; p > 0.7).


CONCLUSIONS
In this sample of routine clinical practice DES reduced repeat intervention of the stented segment to a lesser extent than has been reported in randomized trials. For our cohort, the reduction in restenosis was offset by increased use of additional interventional procedures to treat remote segments, predominantly within the first 2 months after initial stenting.
Yock
Cynthia A
CA
Department of Health Policy, Stanford University School of Medicine, Stanford California 94305-6019, USA. Cynthia.Yock@stanford.edu
Isbill
J Michael
JM
King
Spencer B
SB
Hlatky
Mark A
MA
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D023903:Coronary Restenosis / Q000453:epidemiology*; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008670:Metals; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
D008670:Metals