title: Can intravascular ultrasound guidance modify the efficacy of drug-eluting stent over bare-metal stent in an aorto-ostial lesion?
abstract: OBJECTIVE
  We compared the efficacy of drug-eluting stents (DESs) versus bare-metal stents (BMSs) in de novo and native aorto-ostial lesions (AOLs) guided by intravascular ultrasound (IVUS).
  
  
  METHODS
  Thirty-eight patients underwent DES implantation for 38 AOLs; 35 with sirolimus-eluting stents, and three with paclitaxel-eluting stents (DES group). The control group was composed of 40 AOLs treated by BMS. The incidence of the primary composite end point of all-cause mortality, Q-wave myocardial infarction and target vessel revascularization (TVR) as TVR-major adverse cardiac event (TVR-MACE) was evaluated during a 1-year follow-up. Clinical and IVUS parameters were compared between the DES and BMS groups, and Cox hazards model was used to calculate hazard ratios of several factors for the 1-year TVR-MACE.
  
  
  RESULTS
  Although the vessel, plaque, and stent volumes were significantly larger after the procedures in the DES group owing to longer lesions (18.3 ± 5.1 vs. 13.2 ± 5.9 mm, P<.001), the stent volume index (10.8 ± 2.6 vs. 12.4 ± 3.3, P=.024) was much smaller than that in the BMS group. During the 1-year follow-up, there were 13 TVR-MACEs in all patients (13% in DES vs. 20% in BMS, P=.4 by Kaplan-Meier analysis). The Cox hazards model did not indicate any specific unfavorable factor for the 1-year TVR-MACE.
  
  
  CONCLUSIONS
  The present study showed equality between DES and BMS on de novo and native AOLs about the 1-year TVR-MACE rate, even though a DES was used in longer and bulkier lesions as compared to BMS.
authors.affiliation: Cardiology Department, International University of Health and Welfare, Mita Hospital, Tokyo, Japan. tmsb105@gmail.com
authors.forename: Teruo
authors.initials: T
authors.lastname: Okabe
authors.forename: Akio
authors.initials: A
authors.lastname: Kawamura
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Maekawa
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Anzai
authors.forename: Shiro
authors.initials: S
authors.lastname: Iwanaga
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D002317:Cardiovascular Agents; D008670:Metals; D017239:Paclitaxel; D020123:Sirolimus