title: Extended Outcomes of Complex Coronary Disease in the Drug Eluting Stent Era.
abstract: BACKGROUND
  Several randomized trials comparing bare-metal stents to Drug-Eluting Stents (DES) have demonstrated a significant reduction in Target Vessel Revascularization (TVR) and Target Lesion Revascularization (TLR) exists with the use of drug-eluting stents, without compromising survival. These conclusions are based on restricted inclusion criteria for patients and lesion. It is unknown if these results can be generalized to an unselected patient population and more complex disease. The objective of this study was to determine to what extent the availability of DES has impacted survival, TVR, and TLR in a large regional experience without the restriction of on-label indications.
  
  
  METHODS
  Patients registered with the Northern New England Cardiovascular Disease Study Group's PCI registry with single vessel coronary disease undergoing a first PCI were sorted according to the Bare-Metal stent (BMS) era (2001 - 2002) or the Drug-Eluting stent (DES) era (2004 - 2005) based on the time period their first PCI took place. Totally, 6,093 BMS and 5,651 DES patients were identified. Outcomes of survival, TLR and TVR were measured after one year.
  
  
  RESULTS
  After 1 year, survival was comparable, TLR was reduced by 4.9% (absolute) and TVR was reduced by 5.4% (absolute) in the DES era compared to the BMS era. The TLR/TVR differences remained significant after propensity matching in the DES era vs BMS era (Mortality: HR 1.00, 95% CI: 0.83 - 1.28; TLR: HR 0.40, 95% CI 0.32 - 0.46; TVR: HR 0.44, 95% CI 0.38 - 0.51).
  
  
  CONCLUSIONS
  In large regional experience with a consecutive series of patients representing the contemporary practice of PCI, including both on and off label use, the frequent use of DES reduces the risk of TVR and TLR without compromising survival.
authors.affiliation: Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Desrosiers
authors.affiliation: Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA.
authors.forename: Jeremiah R
authors.initials: JR
authors.lastname: Brown
authors.affiliation: Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Langner
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA.
authors.forename: Mandeep S
authors.initials: MS
authors.lastname: Sidhu
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA.
authors.forename: John F
authors.initials: JF
authors.lastname: Robb
authors.affiliation: Catholic Medical Center, Manchester, NH, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Hearne
authors.affiliation: Eastern Maine Medical Center, Bangor, ME, USA.
authors.forename: Peter M Ver
authors.initials: PM
authors.lastname: Lee
authors.affiliation: Maine Medical Center, Portland, ME, USA.
authors.forename: Mirle A
authors.initials: MA
authors.lastname: Kellett
authors.affiliation: Maine Medical Center, Portland, ME, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Ryan
authors.affiliation: Maine Medical Center, Portland, ME, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: O'Meara
authors.affiliation: Fletcher Allen Health Care, Burlington, VT, USA.
authors.forename: Harold L
authors.initials: HL
authors.lastname: Dauerman
authors.affiliation: Fletcher Allen Health Care, Burlington, VT, USA.
authors.forename: M Theodore
authors.initials: MT
authors.lastname: Silver
authors.affiliation: Department of Invasive Cardiology and Vascular Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Thompson
authors.affiliation: Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Malenka
keywords: Paclitaxel; Restenosis; Revascularization; Sirolimus; Stent