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Outcomes of small coronary artery stenting with bare‐metal stents versus drug‐eluting stents: Results from the NHLBI dynamic registry
Author(s) -
Parikh Shailja V.,
Luna Michael,
Selzer Faith,
Marroquin Oscar C.,
Mulukutla Suresh R.,
Abbott J. Dawn,
Holper Elizabeth M.
Publication year - 2013
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.23194
Subject(s) - medicine , percutaneous coronary intervention , conventional pci , cardiology , hazard ratio , stent , artery , confidence interval , coronary arteries , target lesion , revascularization , bare metal stent , drug eluting stent , surgery , myocardial infarction
Objectives Examine 1‐year outcomes of patients with small coronary arteries in the National Heart, Lung, and Blood Institute Dynamic Registry (NHLBI) undergoing drug‐eluting stent (DES) vs. bare‐metal stent (BMS) placement. Background While randomized trials of DES vs. BMS demonstrate reduced target vessel revascularization, it is unclear whether similar outcomes are seen in unselected patients after percutaneous coronary intervention (PCI) for small coronary arteries. Methods Utilizing patients from the NHLBI Registry Waves 1–3 for BMS (1997–2002) and Waves 4–5 for DES (2004 and 2006), demographic, angiographic, in‐hospital, and 1‐year outcome data of patients with small coronary arteries treated with BMS ( n = 686) vs. DES ( n = 669) were evaluated. Small coronary artery was defined as 2.50–3.00 mm in diameter. Results Compared to BMS‐treated patients, the mean lesion length of treated lesions was longer in the DES treated group (16.7 vs. 13.1 mm, P < 0.001) and the mean reference vessel size of attempted lesions was smaller (2.6 vs. 2.7 mm, P < 0.001). Adjusted analyses of 1‐year outcomes revealed that DES patients were at lower risk to undergo coronary artery bypass graft surgery (Hazard Ratio [HR] 0.40, 95% confidence interval [CI] 0.17–0.95, P = 0.04), repeat PCI (HR 0.53, 95% CI 0.35–0.82, P = 0.004), and experience the combined major adverse cardiovascular event rate (HR 0.59, 95% CI 0.42–0.83, P = 0.002). There was no difference in the risk of death and myocardial infarction (MI) (HR 0.78, 95% CI 0.46–1.35, P = 0.38). Conclusions In this real‐world registry, patients with small coronary arteries treated with DES had significantly lower rates of repeat revascularization and major adverse cardiovascular events at 1 year compared to patients treated with BMS, with no increase in the risk of death and MI. These data confirm the efficacy and safety of DES over BMS in the treatment of small coronary arteries in routine clinical practice. © 2011 Wiley Periodicals, Inc.