title: The impact of drug eluting stents availability on the treatment choice among medical therapy, percutaneous or surgical revascularisation and on 4-year clinical outcome in patients with coronary artery disease: a cohort study.
abstract: OBJECTIVE
  To investigate the influence of the availability of drug eluting stents (DES) on treatment choice (TC) among medical therapy (MT), coronary   by-pass surgery (CABG) or percutaneous coronary interventions (PCI) and the consequent clinical outcomes in patients hospitalised because of coronary artery disease (CAD).
  
  
  METHODS
  Observational study comparing two cohorts hospitalised immediately before, and 3 years after DES availability.
  
  
  METHODS
  Thirteen hospitals with cardiology facilities.
  
  
  METHODS
  2131 consecutive patients with at least one coronary stenosis >50% at coronary angiography (CA) after exclusion of those with acute myocardial infarction or previous CABG or associated relevant valvular disease.
  
  
  METHODS
  Treatment choice after CA and 4-year clinical outcomes.
  
  
  RESULTS
  TC among MT (27% vs 29.2%), PCI (58.6% vs 55.5%) and CABG (14.5% vs 15.3%) was similar in the DES and bare metal stent (BMS) periods (p = 0.51). At least one DES was implanted in 57% of patients treated with PCI in 2005. After 4 years, no difference in mortality (13.8% vs 13.2%, p = 0.72), hospital admissions for myocardial infarction (6.6% vs 5.2%, p = 0.26), stroke (2.2% vs 1.7%, p = 0.49) and further revascularisations (22.3% vs 19.7%, p = 0.25) were observed in patients enrolled in the DES and BMS periods. Only in patients with Syntax score 23-32 a significant change of TC (p = 0.0002) occurred in the DES versus BMS period: MT in 17.4% vs 31%, PCI in 62.2% vs 35.8%, CABG in 20.3% vs 33.2%, with similar 4-year combined end-point of mortality, stroke, myocardial infarction and further revascularisations (45.3% vs 34.2%, p = 0.087).
  
  
  CONCLUSIONS
  Three years after DES availability, the TC in patients with CAD has not changed significantly as well as the 4-year incidence of death, myocardial infarction, stroke and further revascularisations. In subgroup with Syntax score 23-32, a significant increase of indications to PCI was observed in the DES period, without any improvement of the 4-year clinical outcome.
authors.affiliation: Cardiovascular Department, Cà Foncello Hospital, Treviso, Italy.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Olivari
authors.forename: Paolo
authors.initials: P
authors.lastname: Stritoni
authors.forename: Claudio
authors.initials: C
authors.lastname: Burelli
authors.forename: Domenico
authors.initials: D
authors.lastname: Scalia
authors.forename: Stefano
authors.initials: S
authors.lastname: Brocco
authors.forename: Ugo
authors.initials: U
authors.lastname: Fedeli
authors.forename: Francesco
authors.initials: F
authors.lastname: Avossa
authors.forename: Dario
authors.initials: D
authors.lastname: Ferlin
authors.forename: Bernhard
authors.initials: B
authors.lastname: Reimers
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Grassi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fontanelli
authors.forename: Carlo
authors.initials: C
authors.lastname: Valfrè