Long-term clinical outcome of chronic total occlusive lesions treated with drug-eluting stents: comparison of sirolimus-eluting and paclitaxel-eluting stents.
BACKGROUND
There are few studies comparing the efficacy of different drug-eluting stents and their long-term clinical outcomes in percutaneous coronary intervention (PCI) of chronic total occlusive (CTO) lesions.


RESULTS
To compare the efficacy of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) for CTO, and to identify predictors of outcome after PCI, 200 patients with at least 1 successfully revascularized CTO were enrolled into either a SES (n=132) or PES (n=71) group. At 6-9-month angiographic follow-up, SES was superior to PES (late loss 0.27+/-0.60 vs 0.53+/-0.62 mm, P=0.04). During mean follow-up of 2 years, the SES group had a significantly lower cumulative target vessel failure (TVF) rate than the PES group (14.9% vs 28.4%, P=0.01), as a consequence of lower target vessel revascularization (9.7% vs 23.9%, P=0.01) and also a partially lower rate of myocardial infarction (MI: 3.1% vs 7.6%, P=0.04). SES was also superior to PES in both early (<or=9 months) and late (>9 months) TVF (P=0.02 for log-rank test, respectively). Predictors for TVF were use of PES (hazard ratio (HR) 3.81, P<0.01), previous history of MI (HR 4.06, P<0.01), diabetes (HR 2.07, P=0.04) and chronic kidney disease (CKD; HR 3.56, P=0.05).


CONCLUSIONS
CTO lesions treated with SES showed better angiographic and long-term clinical outcomes than those treated with PES. Factors such as stent type, infarct-related CTO, diabetes and CKD affect the outcome of CTO intervention.
Lee
Seung-Pyo
SP
Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
Kim
Song-Yi
SY
Park
Kyung-Woo
KW
Shin
Dong-Ho
DH
Kang
Hyun-Jae
HJ
Koo
Bon-Kwon
BK
Suh
Jung-Won
JW
Cho
Young-Seok
YS
Yeon
Tae-Jin
TJ
Chae
In-Ho
IH
Choi
Dong-Ju
DJ
Kim
Hyo-Soo
HS
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D002908:Chronic Disease; D015331:Cohort Studies; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D017239:Paclitaxel; D012008:Recurrence; D012042:Registries; D020123:Sirolimus; D017211:Treatment Failure; D016896:Treatment Outcome
D017239:Paclitaxel; D020123:Sirolimus