Comparison between Exclusive and Selective Drug-Eluting Stent Strategies in Treating Patients with Multivessel Coronary Artery Disease.
BACKGROUND
The expanded usage of drug-eluting stents (DES) in treating patients with multivessel coronary artery disease (CAD) may sometimes be limited in real-world practice due to cost concerns. We compared the clinical outcomes of exclusive and selective DES use in treating patients with multivessel CAD.


METHODS
From November 2004 to December 2011, 110 patients with multivessel CAD who received four or more stents were enrolled into this study, and divided into two groups according to the DES strategy employed: exclusive DES (n = 52), or selective DES (n = 58). In the selective DES group, DES was reserved for complex lesions only, such that the incidence and predictors of clinical events were assessed.


RESULTS
At a mean follow-up of 41.4 ± 26.5 months, there were no significant differences between the two strategies in terms of baseline characteristics, all-cause mortality (exclusive vs. selective: 1.9% vs. 6.9%, p = 0.21), cardiac death (1.9% vs. 1.7%, p = 0.94) and nonfatal myocardial infarction (3.8% vs. 5.2%, p = 0.74). Despite the presence of more ostial lesions in the exclusive DES group, there was a trend such that major adverse cardiac events (MACE) and target lesion revascularization (TLR) rates were higher in the selective DES group (MACE: 17.3% vs. 31%, p = 0.16; TLR: 11.5% vs. 24.1%, p = 0.08). The higher MACE rate in the selective DES group was mainly driven by a higher target vessel revascularization (TVR) rate (15.4% vs. 29.3%, p = 0.08). In the exclusive DES group, SYNTAX score was an independent predictor of MACE [Haxard ratio (HR): 1.09, 95% confidence internal (CI): 1.02-1.16, p = 0.01] and TVR (HR 1.08, 95% CI 1.01-1.15, p = 0.04).


CONCLUSIONS
Compared to the exclusive DES strategy, the selective DES strategy with reservation of DES for complex lesions is associated with numerically higher, but not statistically significant, rates of MACE and all-cause mortality in this small group of patients with multivessel CAD receiving four or more stents.


BACKGROUND
Bare metal stent; Drug-eluting stent; Multivessel coronary artery disease.
The First Cardiovascular Division, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan;
Ying-Chang
YC
Tung
Department of Cardiology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
Ping-Gune
PG
Hsiao
The First Cardiovascular Division, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan;
Lung-An
LA
Hsu
The First Cardiovascular Division, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan;
Chi-Tai
CT
Kuo
The First Cardiovascular Division, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan;
Chi-Jen
CJ
Chang