Five-year clinical results of coronary angioplasty with drug-eluting stents. National initiative in strategic innovation, iNOS.
BACKGROUND
The use of drug-eluting stents (DES) is beneficial in patients undergoing percutaneous coronary intervention (PCI) and there is particular interest in long-term follow-up.


OBJECTIVE
We aimed to assess and characterize early DES use in Portugal during 2003 and patient follow-up over a 5-year period. We developed a web-based database to collect and organize patient and procedural data from PCI performed in ten cardiovascular interventional centers sharing the same database.


METHODS
This was a multicenter retrospective study that included 1833 consecutive angiographically successful coronary angioplasties in which a DES was implanted in 2003. A subgroup of patients with 5-year clinical follow-up after the initial procedure was selected for which there was at least a 90% follow-up rate during one quarter of 2003. Demographic, clinical and angiographic characteristics of the entire population were assessed. In the clinical follow-up cohort, the incidence of major adverse cardiac events (MACE)--death, myocardial infarction and surgical or percutaneous target lesion revascularization--was analyzed by survival curves and logistic regression analysis.


RESULTS
Of the total population, 23% were female, and mean age was 62 +/- 11 years (25-92). The main risk factors were hypertension (60.5%), dyslipidemia (42.9%), smoking (45.1%) and diabetes (23.9%, of whom 13.2% were on insulin therapy). There was a history of myocardial infarction, PCI or bypass surgery respectively in 23.1%, 25.1%, and 9.7% of the patients. Multivessel disease was present in 59.9% of patients (mean of 1.86 +/- 0.81 vessels). PCI was performed on average in 1.24 +/- 0.48 lesions, and complete revascularization in 58.8%. A total of 2058 stents were used (mean of 1.62 +/- 0.84) in 1271 patients. The longitudinal substudy included only 320 PCIs, for which follow-up was achieved in 319 (99%; median: 1875 days, P25: 1457 days, P75: 2045 days). Thirty-seven deaths (11.6%) and 61 MACE (19.1%) occurred in this group, with no differences between insulin-treated and other diabetic patients.


CONCLUSIONS
This is the first study to analyze the early Portuguese experience with drug-eluting stents. The clinical results compare favorably with the first published international registries. The on-line platform used was successful in collecting data in a standardized format on the clinical experience of multiple centers.
Baptista
José
J
Unidade de Intervenção Cardiovascular, Hospital de Santa Cuz, Carnaxide. josebaptista@spc.pt
Teles
Rui Campante
RC
da Silva
Pedro Canas
PC
Pereira
Hélder
H
Marques
Leitão
L
Santos
Ricardo
R
Carvalho
Henrique
H
Martins
Dinis
D
Farto e Abreu
Pedro
P
Araújo
Jorge
J
Teles
Rui Campante
RC
Almeida
Manuel
M
Raposo
Luis
L
da Silva
Pedro Canas
PC
Gabriel
Henrique Mesquita
HM
Pereira
Helder
H
Vinhas
Hugo
H
Leitão-Marques
António
A
Costa
Marco
M
Baptista
José
J
Santos
Ricardo
R
Seixo
Filipe
F
Farto e Abreu
Pedro
P
Carvalho
Henrique
H
Luz
André
A
Martins
Dinis
D
Araújo
Jorge
J
Silva
Bruno
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D003131:Combined Modality Therapy; D023921:Coronary Stenosis / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors