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| Selective versus Exclusive Use of Sirolimus-eluting Stent
in Multivessel Disease
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| Cardiovascular Center, Korea University Guro Hospital¹ , Washington Hospital Center, Washington DC² |
| Seung-Woon Rha¹, Soon Yong Suh¹ , Byoung Won Cheon¹ , Soon Jun Hong¹ , Jin Won Kim¹ , Chang Gyu Park¹ , Hong Seog Seo¹ , Dong Joo Oh¹ , Young Moo Ro¹ , Ron Waksman² |
Background: Sirolimus-Eluting Stents (SES, CypherTM) showed reduction of restenosis rate when compared bare metal stents (BMS) in a specific subset of coronary lesions. Reimbursement is limited to only one SES and an exclusive use of SES is prohibitively costly. The purpose of this study was to evaluate the strategy of exclusive use of two SES versus combination of one BMS and one SES for two vessel disease.
Methods: A total 179 patients (pts) with 297 lesions who were subjected to PCI with exclusive use of two SES (Exclusive group) were compared with 217 pts with 220 lesions with the use of one SES plus one BMS (Selective group). Selection of stents was based on the physician’s discretion, label use, and stent availability. The in-hospital, 30-day and 6-month clinical outcomes in both groups were compared.
Results: Baseline clinical and angiographic parameters were similar between both groups except less previous coronary artery bypass graft (CABG 9.1% vs. 17.1%, P=0.02), more diabetes (38.5% vs. 29.3%, P=0.05) and restenosis lesions (11.1% vs. 4.1%, P=0.004) in the Selective group. Mean SES length and diameter were similar in both groups. In-hospital periprocedural ischemic events and major CK-MB elevation (3X normal) and 30-day clinical outcomes were similar in both groups but the Exclusive group had higher incidence of intimal dissection (2.0% vs. 0.0%, P=0.05) and intra-arterial balloon pump use (3.9% vs. 0.9%. P=0.05). At 6 months, there were trends toward higher target vessel revascularization (TVR, 9.7% vs. 4.0%, P=0.10) and TVR-major adverse cardiac events (MACE, 18.4% vs. 9.4%, P=0.06) in the Exclusive group. In the Selective group, target lesion revascularization (TLR) and TVR occurred with similar frequency at 6 months in BMS and SES.
Conclusion: Selective Use of SES combining with BMS in pts undergoing PCI that requires >1 stent is safe, feasible and associated with favorable procedural, 30-day and 6-month clinical outcomes compared to exclusive use of SES. This strategy can lower the cost burden for pts with multivessel disease.
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