Document Detail


Clinical outcomes after multilesion percutaneous coronary intervention: comparison between exclusive and selective use of drug-eluting stents.
MedLine Citation:
PMID:  18316823     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This study compared acute and late outcomes following a strategy of selective drug-eluting stent (DES) use guided by a set of 4 criteria defining higher risk of in-stent restenosis compared to an exclusive DES strategy in 362 patients with multilesion (n = 900) percutaneous coronary interventions. RESULTS: At a mean follow up of 412 +/- 110 days, major adverse cardiac events (death, myocardial infarction, revascularization) were 16.8% in the exclusive DES group compared to 18.4% in the selective DES group (p = 0.78). By univariate analysis, revascularization rates (9.9% in the exclusive DES group versus 10.5% in the selective DES group; p = 1.0) and target lesion revascularization (TLR) rates (5.5% versus 6.2%; p = 0.77) were similar in the 2 groups. By multivariate analysis adjusted by propensity score to account for differences in baseline characteristics, the strategy of exclusive DES use was not associated with lower risks of revascularization (hazard ratio [HR]: 0.91, 95% confidence interval [CI] 0.64-1.29) or TLR (HR: 0.81, 95% CI 0.59-1.08) compared with selective DES use. Using the Academic Research Consortium criteria, stent thrombosis occurred in 6/161 (3.7%) cases in the exclusive DES group and in 1/201 (0.5%) case in the selective DES group (p = 0.03). CONCLUSIONS: In patients with multiple coronary lesions, a selective DES strategy for lesions at higher risk of restenosis and bare-metal stents for other lesions was safe and effective when compared to the exclusive use of DES. A large, prospective, randomized trial is required to validate a criteria-based selective DES strategy compared to systematic DES use.
Authors:
Olivier F Bertrand; Benjamin Faurie; Eric Larose; Can Manh Nguyen; Onil Gleeton; Jean-Pierre Déry; Bernard Noël; Guy Proulx; Louis Roy; Olivier Costerousse; Robert De Larochellière; Josep Rodés-Cabau
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Journal of invasive cardiology     Volume:  20     ISSN:  1557-2501     ISO Abbreviation:  J Invasive Cardiol     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-03-04     Completed Date:  2008-09-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8917477     Medline TA:  J Invasive Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  99-104     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie, affilié à l'Université Laval, 2725, Chemin Ste Foy, Québec, Canada, G1V 4G5. olivier.bertrand@crhl.ulaval.ca
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Transluminal, Percutaneous Coronary / economics,  methods*
Coronary Artery Disease / therapy*
Coronary Restenosis / drug therapy,  etiology,  prevention & control
Coronary Thrombosis / drug therapy,  etiology,  prevention & control
Drug-Eluting Stents* / adverse effects
Female
Follow-Up Studies
Health Care Costs
Humans
Male
Middle Aged
Patient Selection
Platelet Aggregation Inhibitors / economics,  therapeutic use
Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors
Quebec
Retrospective Studies
Stents* / adverse effects
Ticlopidine / analogs & derivatives,  economics,  therapeutic use
Treatment Outcome
Chemical
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; 0/Platelet Glycoprotein GPIIb-IIIa Complex; 55142-85-3/Ticlopidine; 90055-48-4/clopidogrel
Comments/Corrections
Comment In:
J Invasive Cardiol. 2008 Mar;20(3):105-6   [PMID:  18316824 ]

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


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