Long-term outcomes with cobalt-chromium bare-metal vs. drug-eluting stents: the REgistro regionale AngiopLastiche dell'Emilia-Romagna registry.
OBJECTIVE
To compare the long-term efficacy of cobalt-chromium bare-metal stents (CCSs) with that of first-generation drug-eluting stents (DESs) in patients within a large real-world multicentre registry.


METHODS
The incidence of major adverse cardiac events [death, acute myocardial infarction, and target-vessel revascularization (TVR)] and angiographic stent thrombosis were assessed in consecutive patients undergoing percutaneous coronary intervention with CCS (n = 1103) or DES (n = 5195) during 2-year follow-up. Propensity score-adjusted outcomes, overall and in patients with low (≤ 10%), intermediate (10-15%), and high (>15%) 1-year restenosis risk, were estimated.


RESULTS
DES-treated patients had significantly higher rates of diabetes, longer lesions, and smaller vessel diameters than CCS-treated patients (all P < 0.0001). However, CCS patients were older and presented a higher rate of hypertension, previous myocardial infarction, and heart failure (all P < 0.01). At 2 years, adjusted rates of myocardial infarction, death, and cumulative-stent thrombosis were similar for DES and CCS. DES provided statistically significant (P < 0.01) reductions in TVR and adjusted major adverse cardiac event rates (9.7 and 17.2%, respectively) compared with CCS (13.2 and 21.2%, respectively). In patients at highest and intermediate risk of restenosis, adjusted TVR rates were significantly (P < 0.01) lower with DES (12.2 and 8.9%, respectively) than CCS (19.9 and 17.1%, respectively), but rates were similar in low-risk patients.


CONCLUSIONS
DESs were more effective than CCSs in lowering TVR rates in patients with an intermediate-high baseline restenosis risk.
Manari
Antonio
A
Cardiologia Interventistica, Azienda Ospedaliera S. Maria Nuova, Reggio Emilia, Italy. Antonio.Manari@asmn.re.it
Ortolani
Paolo
P
Guastaroba
Paolo
P
Marzaroli
Paolo
P
Menozzi
Mila
M
Magnavacchi
Paolo
P
Varani
Elisabetta
E
Vignali
Luigi
L
Campo
Gianluca
G
Marzocchi
Antonio
A
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016009:Chi-Square Distribution; D002858:Chromium Alloys; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011474:Prosthesis Design; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
D002858:Chromium Alloys; D010975:Platelet Aggregation Inhibitors