Document Detail


Are drug-eluting stents indicated in large coronary arteries? Insights from a multi-centre percutaneous coronary intervention registry.
MedLine Citation:
PMID:  18706719     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Restenosis rates are low in large coronary vessels >/=3.5 mm after bare-metal stent (BMS) implantation. The benefit of drug-eluting stents (DES) in large vessels is not established. OBJECTIVE: We aim to assess clinical outcomes after deployment of BMS compared to DES in patients with large coronary vessels >/=3.5 mm. METHODS: We analysed 672 consecutive patients undergoing percutaneous coronary interventions with >/=3.5 mm stent implantation in native coronary artery de-novo lesions from the Melbourne Interventional Group (MIG) registry. Baseline characteristics, 30-day and 12-month outcomes of patients receiving BMS were compared to DES. Multivariate analysis was performed to identify predictors of major adverse cardiac events [MACE, consisting of death, myocardial infarction (MI) and target vessel revascularisation (TVR)]. RESULTS: Of the 672 PCIs performed in 844 lesions, DES was implanted in 39.5% (n=333) and BMS in 60.5% (n=511) of lesions. Patients who received DES compared to BMS were older, more likely to be diabetic, had left ventricular dysfunction <45% or complex lesions. Significantly fewer patients who presented with ST-elevation MI received DES compared to BMS. There were no significant differences in 12-month mortality (0.5 vs. 2.9%, p=0.07), TVR (3.6 vs. 4.8%, p=0.54), MI (6.3 vs. 3.4%, p=0.15), stent thrombosis (0.9 vs. 1.0%, p=0.88), or MACE (9.4 vs. 9.4%, p=0.90) in patients who received DES vs. BMS. Stent length >/=20 mm was the only independent predictor of 12-month MACE (Odds Ratio 2.07, 95% CI 1.14-3.76, p=0.02). CONCLUSION: In this registry, BMS implantation in large native coronary vessels >/=3.5 mm was associated with a low risk of MACE and repeat revascularization at 12 months that was comparable to DES.
Authors:
Bryan P Yan; Andrew E Ajani; Gishel New; Stephen J Duffy; Omar Farouque; James Shaw; Martin Sebastian; Robert Lew; Angela Brennan; Nick Andrianopoulos; Chris Reid; David J Clark;
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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2008-08-15
Journal Detail:
Title:  International journal of cardiology     Volume:  130     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-11-17     Completed Date:  2009-02-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  374-9     Citation Subset:  IM    
Affiliation:
Department of Cardiology of the Royal Melbourne Hospital, Australia.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Transluminal, Percutaneous Coronary
Coronary Artery Disease / epidemiology*,  therapy*
Coronary Restenosis / epidemiology*
Coronary Vessels
Disease-Free Survival
Drug-Eluting Stents / statistics & numerical data*
Female
Humans
Kaplan-Meiers Estimate
Male
Metals
Middle Aged
Predictive Value of Tests
Registries / statistics & numerical data*
Risk Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Metals
Investigator
Investigator/Affiliation:
S J Duffy / ; J A Shaw / ; A Walton / ; C Farrington / ; A Dart / ; M Freilich / ; R Gunaratne / ; A Broughton / ; J Federman / ; C Keighley / ; M Butler / ; D J Clark / ; O Farouque / ; K Charter / ; M Horrigan / ; J Johns / ; L Oliver / ; J Brennan / ; R Chan / ; G Proimos / ; T Dortimer / ; B Chan / ; D Fernando / ; R Huq / ; A Tonkin / ; L Brown / ; A Sahar / ; M Freeman / ; H S Lim / ; A Al-Fiadh / ; G New / ; L Roberts / ; H Liew / ; M Rowe / ; G Proimos / ; N Cheong / ; C Goods / ; D Fernando / ; A Teh / ; C C S Lim / ; P Joy / ; R Lew / ; G Szto / ; R Teperman / ; R Templin / ; A Black / ; M Sebastian / ; T Yip / ; M Rahman / ; J Aithal / ; J Dyson / ; T Du Plessis / ; H Krum / ; C Reid / ; N Andrianopoulos / ; A Brennan / ; P Loane / ; L Curran / ; F Groen / ; G Szto / ; V O'Shea / ; A E Ajani / ; R Warren / ; D Eccleston / ; J Lefkovits / ; B P Yan / ; P Roy / ; R Gurvitch / ; M Sallaberger / ; Y L Lim / ; D Eccleston / ; A Walton /

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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