title: Simultaneous drug-eluting and bare-metal stent implantation: long-term clinical outcome and findings of clinically indicated coronary angiography.
abstract: BACKGROUND
  Simultaneous drug-eluting stent (DES) and bare-metal stent (BMS) implantation is occasionally employed in clinical practice, but its long-term clinical and angiographic outcome is not clear.
  
  
  OBJECTIVE
  We aimed to describe the long-term clinical outcome and the findings of clinically indicated coronary angiography in patients subjected to simultaneous DES and BMS implantation ("hybrid stenting").
  
  
  METHODS
  We identified 236 patients (mean age 62.9 ± 11.4 years, 76.7% men) who had undergone percutaneous coronary intervention with at least 1 DES and 1 BMS. At a median follow-up of 42 months (range, 6-89 months) available in 222 patients, 13 (5.9%) patients died from cardiac causes, 13 (5.9%) experienced nonfatal acute myocardial infarction, and 24 (10.8%) experienced unstable angina. Clinically indicated repeat coronary angiography was performed in 64 patients (28.8%).
  
  
  RESULTS
  Thirty-one patients (14%) had target lesion revascularization (TLR). The DES demonstrated lower TLR rates (15.9% vs 36.9%, P = 0.002) and lower late loss (0.44 ± 0.5 mm vs 0.68 ± 0.7 mm, P = 0.009) compared with BMS. Use of DES was independently associated with lower risk for binary restenosis (hazard ratio [HR]: 0.41, 95% confidence interval [CI]: 0.19-0.89, P = 0.03) and TLR (HR: 0.26, 95% CI: 0.12-0.54, P<0.001).
  
  
  CONCLUSIONS
  Although a hybrid stenting strategy demonstrates a reasonable long-term prognosis even in high-risk patients, DES have a better angiographic outcome compared with BMS under the influence of common patient-related restenosis risk factors.
authors.affiliation: Cardiology Department, Patras University Hospital, Rio, Patras, Greece. dalex@med.upatras.gr
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Alexopoulos
authors.forename: Ioanna
authors.initials: I
authors.lastname: Xanthopoulou
authors.forename: Vasileios
authors.initials: V
authors.lastname: Karantalis
authors.forename: Georgia
authors.initials: G
authors.lastname: Mitropoulou
authors.forename: Anastasia
authors.initials: A
authors.lastname: Damelou
authors.forename: Periklis
authors.initials: P
authors.lastname: Davlouros
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D001241:Aspirin / Q000627:therapeutic use; D000077144:Clopidogrel; D016001:Confidence Intervals; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000517:prevention & control* / Q000628:therapy; D023903:Coronary Restenosis / Q000517:prevention & control* / Q000628:therapy; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017239:Paclitaxel / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D013223:Statistics as Topic; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D017239:Paclitaxel; D001241:Aspirin