FOCUS ISSUE: CARDIAC INTERVENTION: FOCUS ISSUE: CARDIAC INTERVENTIONSIROLIMUS-PACLITAXEL COMPARISON
Vessel Size and Outcome After Coronary Drug-Eluting Stent Placement
Results From a Large Cohort of Patients Treated With Sirolimus- or Paclitaxel-Eluting Stents
Shpend Elezi, MD*,
Alban Dibra, MD*,
Julinda Mehilli, MD*,
Jürgen Pache, MD*,
Rainer Wessely, MD*,
Albert Schömig, MD and
Adnan Kastrati, MD*,*
* Deutsches Herzzentrum, Technische Universität
First Medizinische Klinik rechts der Isar, Technische Universität, Munich, Germany
Manuscript received February 27, 2006;
revised manuscript received May 3, 2006,
accepted May 16, 2006.
* Reprint requests and correspondence: Dr. Adnan Kastrati, Deutsches Herzzentrum, Lazarettstr. 36, 80636 Munich, Germany. (Email: kastrati{at}dhm.mhn.de).
OBJECTIVES: This study sought to investigate the influence of vessel size on the outcomes of patients after drug-eluting stent (DES) implantation.
BACKGROUND: There are no dedicated studies on the influence of vessel size on the outcomes of patients treated with different DES.
METHODS: The study population was composed of 2,058 consecutive patients who received sirolimus-eluting stents (SES) or paclitaxel-eluting stents (PES). Patients were grouped into tertiles according to vessel size (<2.41 mm in the lower tertile, 2.41 to 2.84 mm in the middle tertile, and >2.84 mm in the upper tertile). The primary end point was target lesion revascularization (TLR). Secondary end points were binary angiographic restenosis and the composite of death or myocardial infarction.
RESULTS: Vessel size did not influence the composite end point of death and myocardial infarction. The TLR rates were higher among patients in the lower tertile (12.1%) as compared with the middle (8.4%) and upper (8.0%) tertiles (p = 0.02). In a multivariate analysis, vessel size emerged an independent predictor of TLR (p = 0.009). The model showed also a significant interaction between DES type and vessel size regarding TLR (p = 0.008). There was a significant difference in TLR rates among patients treated with SESs (8.6%) and PESs (16.4%) in the lower tertile (p = 0.002), but not in the middle and upper tertiles.
CONCLUSIONS: The influence of vessel size on restenosis is related to the specific DES used, with SESs providing better outcomes than PESs in small but not in large coronary vessels.
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Abbreviations and Acronyms
| | BMS = bare-metal stent | | DES = drug-eluting stent | | PES = paclitaxel-eluting stent | | SES = sirolimus-eluting stent | | TLR = target lesion revascularization |
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