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Comparison of drug‐eluting and bare metal stents in large coronary arteries
Author(s) -
Chan Chi Yuen,
Vlachos Helen,
Selzer Faith,
Mulukutla Suresh R.,
Marroquin Oscar C.,
Abbott Dawn J.,
Holper Elizabeth M.,
Williams David O.
Publication year - 2014
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.25339
Subject(s) - medicine , conventional pci , cardiology , coronary arteries , bare metal , hazard ratio , artery , percutaneous coronary intervention , revascularization , target lesion , stent , drug eluting stent , myocardial infarction , restenosis , confidence interval
Objectives This study sought to evaluate the safety and effectiveness of drug‐eluting stents (DES) compared to bare‐metal stents (BMS) for patients with large coronary vessels. Background Randomized trials have demonstrated that DES reduce the risk of target vessel revascularization (TVR) compared to BMS. This benefit is less pronounced as artery diameter increases. Whether DES are superior to BMS for larger coronary arteries in the setting of routine clinical practice is unknown. Methods We analyzed data from 869 patients undergoing de novo lesion PCI with reference vessel diameter greater than or equal to 3.5 mm in the NHLBI Dynamic Registry according to whether they were treated with DES or BMS. Patients were followed for 3 years for the occurrence of cardiovascular events. Results At 3‐year follow‐up, rates of TVR at 3 years were similar and low in both groups (4.4% vs. 3.7%, P = 0.62). After adjustment for differences in baseline characteristics, the adjusted hazard ratio for 3‐year MI for DES was 1.85 (95% CI 0.93–3.7, P = 0.08), for TVR at 3 years 1.14 (95% CI 0.52–2.49, P = 0.75) and for mortality 0.89 (95%CI 0.49–1.62, P = 0.71). Conclusions In our study of the unrestricted use of DES for patients with lesions in larger diameter coronary arteries, first generation DES did not reduce 3‐year risk of TVR. Our findings do not support the preferred use of DES over BMS for patients with lesions located in arteries >3.5 mm. It is unknown whether secondary generation DES can offer better outcome compared to BMS in large coronary vessels. Further study on this issue is warranted. © 2013 Wiley Periodicals, Inc.