title: Comparison of drug-eluting and bare metal stents in large coronary arteries: findings from the NHLBI dynamic registry.
abstract: OBJECTIVE
  This study sought to evaluate the safety and effectiveness of drug-eluting stents (DES) compared to bare-metal stents (BMS) for patients with large coronary vessels.
  
  
  BACKGROUND
  Randomized trials have demonstrated that DES reduce the risk of target vessel revascularization (TVR) compared to BMS. This benefit is less pronounced as artery diameter increases. Whether DES are superior to BMS for larger coronary arteries in the setting of routine clinical practice is unknown.
  
  
  METHODS
  We analyzed data from 869 patients undergoing de novo lesion PCI with reference vessel diameter greater than or equal to 3.5 mm in the NHLBI Dynamic Registry according to whether they were treated with DES or BMS. Patients were followed for 3 years for the occurrence of cardiovascular events.
  
  
  RESULTS
  At 3-year follow-up, rates of TVR at 3 years were similar and low in both groups (4.4% vs. 3.7%, P = 0.62). After adjustment for differences in baseline characteristics, the adjusted hazard ratio for 3-year MI for DES was 1.85 (95% CI 0.93-3.7, P = 0.08), for TVR at 3 years 1.14 (95% CI 0.52-2.49, P = 0.75) and for mortality 0.89 (95%CI 0.49-1.62, P = 0.71).
  
  
  CONCLUSIONS
  In our study of the unrestricted use of DES for patients with lesions in larger diameter coronary arteries, first generation DES did not reduce 3-year risk of TVR. Our findings do not support the preferred use of DES over BMS for patients with lesions located in arteries >3.5 mm. It is unknown whether secondary generation DES can offer better outcome compared to BMS in large coronary vessels. Further study on this issue is warranted.
authors: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Chi Yuen
authors: CY
authors: Chan
authors: Helen
authors: H
authors: Vlachos
authors: Faith
authors: F
authors: Selzer
authors: Suresh R
authors: SR
authors: Mulukutla
authors: Oscar C
authors: OC
authors: Marroquin
authors: Dawn J
authors: DJ
authors: Abbott
authors: Elizabeth M
authors: EM
authors: Holper
authors: David O
authors: DO
authors: Williams
mesh_terms: D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D054555:National Heart, Lung, and Blood Institute (U.S.) / Q000706:statistics & numerical data*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011474:Prosthesis Design; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States
keywords: CAD-coronary artery disease; PCI-percutaneous coronary intervention; RSTN-restenosis