title: Long-term outcomes of drug-eluting stents versus bare-metal stents in large coronary arteries.
abstract: BACKGROUND
  Long-term (>3 years) outcomes of drug-eluting stents (DES) versus bare-metal stents (BMS) in large coronary arteries were not conclusive. In addition, large coronary vessels were defined using a wide size range (≥3.0 mm) in previous studies. The aim of this study was to assess the long-term efficacy of DES versus BMS in subgroups of different vessel sizes.
  
  
  METHODS
  A total of 1096 patients (1342 lesions) who underwent either DES or BMS implantation in large coronary vessels was followed for a mean duration of 4.5 years. Patients were divided into 4 subgroups by the reference vessel diameters (Q1: 3.0-3.25 mm, Q2: 3.26-3.50 mm, Q3: 3.51-3.75 mm, and Q4: 3.76-4.50 mm). The primary endpoint was major adverse cardiac events (MACE), defined as a composite of cardiac death, myocardial infarction, target vessel revascularization, and stent thrombosis. The propensity score-adjusted Cox regression method was applied.
  
  
  RESULTS
  In the 3 subgroups with smaller vessel sizes, the adjusted risk of MACE in DES recipients was reduced by 82% in Q1 (hazard ratio [HR]: 0.18, 95% confidence interval [CI]: 0.09-0.38), 49% in Q2 (HR: 0.51, 95% CI: 0.26-0.98), and 67% in Q3 (HR: 0.33, 95% CI: 0.15-0.73). However, in the largest vessel subgroup (>3.75 mm), all clinical outcomes were not significantly different irrespective of the stent type used.
  
  
  CONCLUSIONS
  The incidence of MACE in 3.0-3.75 mm vessels was significantly reduced by the use of DES than by the use of BMS during a long-term follow-up. However, DES lost its benefit in >3.75 mm vessels.
authors.affiliation: Department of Cardiology and Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Ming-Jer
authors.initials: MJ
authors.lastname: Hsieh
authors.forename: Chun-Chi
authors.initials: CC
authors.lastname: Chen
authors.forename: Shang-Hung
authors.initials: SH
authors.lastname: Chang
authors.forename: Chao-Yung
authors.initials: CY
authors.lastname: Wang
authors.forename: Cheng-Hung
authors.initials: CH
authors.lastname: Lee
authors.forename: Fen-Chiung
authors.initials: FC
authors.lastname: Lin
authors.forename: Chee-Jen
authors.initials: CJ
authors.lastname: Chang
authors.forename: I-Chang
authors.initials: IC
authors.lastname: Hsieh
mesh_terms: D000368:Aged; D003331:Coronary Vessels / Q000473:pathology* / Q000601:surgery*; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008670:Metals / Q000009:adverse effects; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D015607:Stents / Q000009:adverse effects / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008670:Metals
keywords: Bare metal stent; Drug-eluting stent; Large coronary artery; Long-term outcomes