title: Five-year outcomes in patients with chronic total coronary occlusion treated with drug-eluting vs bare-metal stents: a case-control study.
abstract: BACKGROUND
  Limited data exist on long-term safety and effectiveness of drug-eluting stents (DESs) in true chronic total coronary occlusion (CTO) settings. We evaluated 5-year clinical outcomes of patients with CTO treated successfully with DES vs bare-metal stent (BMS).
  
  
  METHODS
  We compared the 5-year clinical outcomes of 156 patients treated with DES implantation with outcomes of a historical cohort of 159 patients treated with BMS. Primary end point was freedom from major adverse cardiac events (MACEs; defined as death, myocardial infarction [MI], and target lesion revascularization [TLR]); secondary end points were freedom from target vessel failure (TVF; combination of target vessel revascularization, MI, and cardiac death) and TLR at 5 years.
  
  
  RESULTS
  After 5 years, the DES group had significantly superior event-free survival from MACE (84% vs 69%; log rank P < 0.001), TVF (71% vs 84%; P = 0.002), and TLR (77% vs 92%; P = 0.0001), compared with the BMS group. The Cox proportional hazards model identified BMS vs DES (adjusted hazard ratio [HR] = 3.37; 95% confidence interval [CI], 1.85-6.17; P = 0.001), final minimal lumen diameter (HR, 0.27; 95% CI, 0.14-0.52; P = 0.0001), and stent length (HR, 1.01; 95% CI, 1.00-1.03; P = 0.03) as independent predictors of MACE at 5-year follow-up. Twelve (7%) and 7 (4%) stent thromboses occurred in the DES and BMS groups (P = 0.23), respectively.
  
  
  CONCLUSIONS
  After 5 years, DESs were superior to BMSs in reducing MACE, TVF, and TLR in patients with CTO and should be the preferred strategy.
authors.affiliation: UO Cardiologia Interventistica Azienda Ospedaliera S. Camillo Forlanini, Roma, Italy. f.defelice@lycos.com
authors.forename: Francesco
authors.initials: F
authors.lastname: De Felice
authors.forename: Rosario
authors.initials: R
authors.lastname: Fiorilli
authors.forename: Antonio
authors.initials: A
authors.lastname: Parma
authors.forename: Carmine
authors.initials: C
authors.lastname: Musto
authors.forename: Marco Stefano
authors.initials: MS
authors.lastname: Nazzaro
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Scappaticci
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Confessore
authors.forename: Elena
authors.initials: E
authors.lastname: Guerra
authors.forename: Flavia
authors.initials: F
authors.lastname: Belloni
authors.forename: Roberto
authors.initials: R
authors.lastname: Violini
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D002908:Chronic Disease; D054059:Coronary Occlusion / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology / Q000601:surgery; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D016016:Proportional Hazards Models; D015607:Stents; D017211:Treatment Failure; D016896:Treatment Outcome