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Impact of stent diameter on outcomes following percutaneous coronary intervention with second‐generation drug‐eluting stents: Results from a large single‐center registry
Author(s) -
Plitt Anna,
Claessen Bimmer E.,
Sartori Samantha,
Baber Usman,
Chandrasekhar Jaya,
Aquino Melissa,
Vijay Pooja,
Elsayed Sherif,
Kovacic Jason C.,
Sweeny Joseph,
Barman Nitin,
Moreno Pedro,
Krishnan Prakash,
Demopoulos Antonia,
Dangas George,
Kini Annapoorna S.,
Mehran Roxana,
Sharma Samin K.
Publication year - 2020
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.28488
Subject(s) - medicine , mace , percutaneous coronary intervention , conventional pci , hazard ratio , myocardial infarction , cardiology , single center , stent , clinical endpoint , proportional hazards model , drug eluting stent , revascularization , surgery , confidence interval , clinical trial
Background In patients treated with bare metal stents and first‐generation drug‐eluting stents (DES) smaller stent diameter (SD) has been associated with worse long term outcomes after percutaneous coronary intervention (PCI). Data on the impact of small SD on outcomes after PCI with second‐generation DES is scarce. Methods Consecutive patients treated with second‐generation DES between 2010 and 2016 were included in a single tertiary center. Patients were grouped according to SD: ≤2.50 mm, 2.75 ≤ 3.00 mm, 3.25 ≤ 3.50 mm, and >3.50 mm. One‐year event rates were estimated using the Kaplan–Meier method and adjusted hazard ratios were generated using Cox regression analysis. The primary endpoint was major adverse cardiac events (MACE; death, myocardial infarction [MI], or target vessel revascularization [TVR]). Results Of the 17,607 patients who underwent PCI with second‐generation DES, 32.6% ( n = 5,741) had SD ≤2.5 mm, 39.1% ( n = 6,890) had SD 2.75 ≤ 3.0 mm, 22.2% ( n = 3,910) had SD 3.25 ≤ 3.5 mm, and 6.1% ( n = 1,066) had SD >3.5 mm. At 1 year, MACE rates were 10.5%, 9.5%, 8.0%, and 8.0%, respectively, with increasing SD ( p = .006). TVR rates decreased with increasing SD (7.2%, 5.8%, 4.7%, and 3.3%, respectively [ p < .0001]) whereas rates of MI across SD groups were comparable (1.7%, 1.9%, 2.0%, and 1.5%, respectively [ p = .60]). After multivariable adjustment, smaller SD remained associated with higher rates of MACE, TVR, and target lesion revascularization. Conclusion In a large cohort of patients undergoing PCI with second‐generation DES, smaller SD was associated with increased MACE, driven by higher rates of repeat revascularization. Further research into the optimal treatment of small coronary arteries is warranted.