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  • Title: Comparison of outcomes of drug-eluting stents versus bare-metal stents in nonostial proximal left anterior descending coronary arteries.
    Author: Bonello L, De Labriolle A, Lemesle G, Roy P, Steinberg DH, Slottow TL, Xue Z, Torguson R, Kaneshige K, Suddath WO, Satler LF, Kent KM, Lindsay J, Pichard AD, Waksman R.
    Journal: Am J Cardiol; 2009 Feb 15; 103(4):496-500. PubMed ID: 19195509.
    Abstract:
    Drug-eluting stents (DES) have reduced the rate of in-stent restenosis compared with bare-metal stents, but are associated with an increased risk of late stent thrombosis. The proximal left anterior descending artery (LAD) is a large vessel and is considered to be at increased risk of both restenosis and stent thrombosis. The risk-benefit ratio of each type of stent therefore is of great clinical interest in this location. The aim was to compare 1-year outcomes of DESs and bare-metal stents in nonostial proximal LADs. Historic cohorts of patients who underwent percutaneous coronary intervention of nonostial proximal LAD lesions were compared. A total of 137 patients in the bare-metal stent group and 350 patients in the DES group were compared. The primary and secondary end points were target-lesion revascularization (TLR) rate and major adverse cardiac event rate, including death, myocardial infarction and TLR at 1-year follow-up. Patients in both groups had similar baseline characteristics. Intravascular ultrasound guidance was used in most percutaneous coronary intervention (bare-metal stents vs DESs 72.4% vs 74.5%; p = 0.6). Stent diameter was large in both groups (3.2 +/- 0.5 vs 3.2 +/- 0.3 mm; p = 0.6). Patients in the DES group had longer stents implanted (15 +/- 7 vs 17 +/- 7 mm; p <0.01). Major adverse cardiac event and TLR rates were not different (bare-metal stents vs DESs 16.4% vs 14.7%; p = 0.7 and 4.5% vs 5.2%; p = 0.8). In multivariate analysis, the TLR rate was independent of type of stent used. In conclusion, DESs carry no clinical benefit over bare-metal stents for nonostial proximal LAD lesions. Bare-metal stents therefore could be a cost-effective alternative in this location.
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