| 조영석¹², 박진식¹, 한주용¹, 강현재¹, 구본권¹, 정우영¹², 연태진¹², 채인호¹², 최동주¹², 김효수¹, 손대원¹, 오병희¹, 박영배¹, 최윤식¹ |
Backgrounds: Randomized clinical trials have shown that drug-eluting stent (DES) significantly reduces restenosis after percutaneous coronary intervention (PCI). However, predictors of target lesion revascularization (TLR) and major adverse cardiovascular events (MACE) after DES implantation in routine clinical setting remain to be determined. Methods and Results: We analyzed data of two-hospital DES registry. From March 2003 to December 2004, 871 patients (male 65%, age 63±10) with 1,155 lesions who underwent PCI with only one kind of DES were included. Diabetes mellitus was present in 300 (34%) patients and about half of the patients (52%) presented as acute coronary syndrome. 636 patients were treated with only Sirolimus-eluting stents (SES) and 235 with only Paclitaxel-eluting stents (PES). Angiographic follow-up was performed in 540 (62%) patients. During follow-up, death occurred in 3.2% of patients and nonfatal myocardial infarction in 0.8%. TLR was performed in 5.1% of patients. The overall rate of MACE was 8.8%. Independent predictors of MACE were diabetes (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.19 to 3.26, p <0.01), the use of PES versus SES (OR 1.94, 95% CI 1.17 to 3.22, p <0.05), and the non-use of statins (OR 1.92, 95% CI 1.10 to 3.34, p <0.05). Among 1,155 lesions, 824 were treated with ≥1 SES and 331 with ≥1 PES. TLR was performed in 4.3% of lesions with repeat PCI except for one case with coronary artery bypass grafting. Independent predictors of TLR were the use of PES versus SES (OR 2.34, 95% CI 1.29 to 4.26, p <0.01), diabetes (OR 2.01, 95% CI 1.11 to 3.65, p <0.05), PCI for restenotic lesion (OR 2.53, 95% CI 1.15 to 5.57, p <0.05), PCI for left main lesion (OR 3.66, 95% CI 1.16 to 11.57, p <0.05), and preprocedural reference diameter (per 0.25 mm decrease; OR 1.25, 95% CI 1.02 to 1.54, p <0.05). Conclusions: In addition to lesion characteristics, clinical variables still have predictive value for TLR in the DES era. Diabetic patients have a higher risk of TLR and MACE compared with non-diabetic patients, and the use of statin shows protective effect for MACE. Our data also suggest that type of DES influence clinical outcomes.
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