Are drug-eluting stents indicated in large coronary arteries? Insights from a multi-centre percutaneous coronary intervention registry

Abstract 

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.

Keywords: Percutaneous coronary intervention, Drug-eluting stents, Bare-metal stents