title: Adjunctive Bare-Metal Stenting Associated With Improved Outcomes in Patients With Multivessel Disease Treated With Drug-Eluting Stents.
abstract: The use of both bare-metal stents (BMSs) and drug-eluting stents (DESs) in the setting of multivessel percutaneous coronary intervention (PCI) continues because of cost considerations.
  
  
  
  A retrospective analysis of patients with ≥ 2 coronary arteries with angiographic stenoses of ≥ 70% severity who were treated with multivessel PCI and ≥ 2 stents between April 2007 and March 2011 was performed using a prospective single-centre PCI registry. Follow-up data were obtained from the Discharge Abstract Database of the Canadian Institute for Health Information and the Registered Persons Database. We performed propensity matching of the DES + BMS and DES-only groups, as well as Cox multiple regression analyses to determine the independent predictors of adverse events.
  
  
  
  A total of 1299 patients (514 in the DES + BMS group and 785 in the DES group) fulfilled the study criteria. Death or repeated revascularization at 5 years occurred less frequently in the DES + BMS group than in the DES group (23.9% ± 2.6% vs 33.1% ± 2.4%; P = 0.01), and major adverse cardiac events (MACE) tended to be less common in the DES + BMS group (31.1% ± 3.0% vs 36.7% ± 2.4%; P = 0.056). Kaplan-Meier estimates revealed an adjusted benefit with the DES + BMS strategy for death (11.4 ± 2.9 vs 14.9 ± 2.8; P = 0.035) and for death and repeated revascularization (25.6 ± 3.5 vs 32.4 ± 3.4; P = 0.034).
  
  
  
  A DES + BMS PCI strategy is associated with a lower incidence of repeated revascularization and MACE at 5-year follow up. For patients undergoing multivessel PCI who have favourable anatomy and clinical features, a combined approach using DES and BMS appears to be a viable option for contemporary PCI practice.
authors.affiliation: Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Noel
authors.initials: N
authors.lastname: Crooks
authors.affiliation: Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Chan
authors.affiliation: Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Joan
authors.initials: J
authors.lastname: Ivanov
authors.affiliation: Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Horlick
authors.affiliation: Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Douglas
authors.initials: D
authors.lastname: Ing
authors.affiliation: Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Overgaard
authors.affiliation: Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada. Electronic address: vlad.dzavik@uhn.ca.
authors.forename: Vladimír
authors.initials: V
authors.lastname: Džavík
mesh_terms: D000367:Age Factors; D002170:Canada / Q000453:epidemiology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D003404:Creatinine / Q000032:analysis; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D057216:Propensity Score; D012042:Registries; D019233:Retreatment / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015607:Stents; D013318:Stroke Volume
chemical_list: D003404:Creatinine