Long-term outcome of patients with very small coronary artery disease: A comparison of drug-eluting and bare metal stents.
BACKGROUND
Among patients with very small vessel disease and chronic kidney disease (CKD), the comparative efficacy of bare metal stents (BMSs) versus drug-eluting stents (DESs) is not frequently addressed. This study aimed to evaluate the long-term outcomes of patients with very small vessel disease managed with percutaneous coronary intervention.


METHODS
Our study included 158 consecutive patients undergoing percutaneous coronary intervention from January 2003 to December 2013. The primary end points were cardiovascular death and target vessel failure, which consisted of cardiovascular death, target vessel-related myocardial infarction, and ischemia-driven target vessel revascularization.


RESULTS
BMSs were used in 37 patients, while DESs were utilized in 121 patients. During the mean follow-up period of 2.7 ± 2.2 years (median 2.1 years; interquartile range, 1.3-4.2 years), the target vessel failure rate was 48.6% versus 28.1% (BMS vs. DES, p = 0.020) and the cardiovascular death rate was 27% versus 18.2% (BMS vs. DES, p = 0.241). The use of a DES (hazard ratio: 0.44, 95% confidence interval: 0.24-0.79, p = 0.006) remained the most significant predictor of target vessel failure after multivariate analysis. In CKD subgroup analysis, the benefit of a 2.25 mm DES was evident only in the subgroup with CKD, but such a benefit disappeared in those without CKD.


CONCLUSIONS
Compared with BMSs, implantation of DESs in a patient population with very small vessel disease effectively reduced target vessel failure. However, the beneficial effects of DESs appeared to be evident only in the subgroup with CKD.
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Wei-Ting
WT
Wang
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
Shih-Hsien
SH
Sung
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
Cheng-Hsueh
CH
Wu
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Shao-Sung
SS
Huang
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Wan-Leong
WL
Chen
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Shing-Jong
SJ
Lin
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC. Electronic address: tmlu@vghtpe.gov.tw.
Tse-Min
TM
Lu
D000368:Aged; D003324:Coronary Artery Disease / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D015607:Stents
D008670:Metals
Bare-metal stent; Chronic kidney disease; Coronary artery disease; Drug-eluting stent; Percutaneous coronary intervention