Document Detail

Patient selection to enhance the long-term benefit of first generation drug-eluting stents for coronary revascularisation procedures. Insights from a large multicentre registry.
MedLine Citation:
PMID:  19577984     Owner:  NLM     Status:  MEDLINE    
AIMS: To evaluate the long-term clinical outcome after drug-eluting stents (DES) implantation, and to test if patient selection could enhance their net clinical benefit. METHODS AND RESULTS: We assessed the incidence of major adverse cardiac events (MACE=death, acute myocardial infarction, and target vessel revascularisation, TVR) and angiographic stent thrombosis (ST) during 3-year follow-up in a prospective multicentre registry. Propensity-score analysis to adjust for different clinical, angiographic and procedural characteristics was performed. Overall, 14,115 patients enrolled in the registry received solely BMS (n=9,565) or DES (n=4,550). The incidence of definite ST was 0.6% for BMS and 1.3% for DES (p=0.003). The propensity-score adjusted incidence of cardiac death and myocardial infarction was similar between the two groups (DES 11.9% vs. BMS 12.1%, HR 0.90, 95% CI 0.77-1.04), whereas DES were associated with lower rates of TVR (DES 11.6% vs. BMS 15.2%, HR 0.67, 95% CI 0.59-0.76). The efficacy of DES in reducing TVR increased with increasing likelihood of TVR at baseline. CONCLUSIONS: The beneficial effect of DES in reducing new revascularisations compared to BMS extends out to three years without a significantly worse overall safety profile. The benefit seems more evident in patients with the highest baseline risk of clinical restenosis.
Francesco Saia; Giancarlo Piovaccari; Antonio Manari; Paolo Guastaroba; Luigi Vignali; Elisabetta Varani; Andrea Santarelli; Alberto Benassi; Armando Liso; Gianluca Campo; Stefano Tondi; Fabio Tarantino; Rossana De Palma; Antonio Marzocchi
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology     Volume:  5     ISSN:  1774-024X     ISO Abbreviation:  -     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-07-06     Completed Date:  2009-07-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101251040     Medline TA:  EuroIntervention     Country:  France    
Other Details:
Languages:  eng     Pagination:  57-66     Citation Subset:  IM    
Istituto di Cardiologia, Università di Bologna, Policlinico S. Orsola-Malpighi, Italy.
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MeSH Terms
Aged, 80 and over
Angioplasty, Transluminal, Percutaneous Coronary / adverse effects,  instrumentation*
Coronary Angiography
Coronary Artery Disease / mortality,  radiography,  therapy*
Coronary Restenosis / etiology,  prevention & control
Coronary Thrombosis / etiology,  prevention & control
Drug-Eluting Stents*
Heart Diseases / etiology,  mortality,  prevention & control*,  radiography
Italy / epidemiology
Middle Aged
Myocardial Infarction / etiology,  prevention & control
Patient Selection*
Proportional Hazards Models
Prospective Studies
Prosthesis Design
Risk Assessment
Time Factors
Treatment Outcome
Reg. No./Substance:

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