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| Comparison of sirolimus-eluting stent and cobalt based thin-strut stent in large coronary arteries :
The two year-follow up result of prospective randomized study
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| 서울대학교 의과대학 내과학 교실, 서울대학교병원 순환기 내과1, 분당 서울대학교병원 순환기 내과2, 조선 대학교 의과 대학 내과학 교실, 조선대학교 병원 순환기 내과3 |
| 황석재1, , 정중화3, 이해영1, 강현재1, 구본권1, 조영석2, 정우영2, 연태진2, 채인호2, 최동주2, 김효수1, 오병희1, 박영배1, 최윤식1 |
Background Sirolimus-eluting stent(Cypher™, Cordis; SES) significantly reduced the rate of restenosis after stent implantation. And cobalt based thinner-strut stents(CTSS) are reported to have lower rate of restenosis than conventional bare metal stent. The present study was performed to compare the long-term clinical outcomes of SES and CTSS(Driver™, Medtronic) in large coronary arteries. Methods and Results 77 patients (80 lesions) with single de novo lesion of a native coronary artery >2.75 to ≤4 mm in diameter, lesion ≤ 20 mm in length who underwent elective stent implantation were enrolled. Patients were randomized to either SES(n=38), or CTSS(n=39). Six-month angiographic results and 2 year clinical results were compared. Major adverse cardiac events were defined as death, myocardial infarction and target lesion revascularization(TLR). There were no differences in baseline clinical characteristics between the 2 groups. Angiographic follow-up rate was 89% and 95% in SES and CTSS group, respectively(p=NS). Mean reference diameter(3.14±0.45mm vs. 3.02±0.41mm, p=0.248) and lesion length(16.2±4.7mm vs. 18.4±7.0 mm, p=0.112) were not different between SES and CTSS groups. Stent length was longer(23.1±4.7mm vs. 17.7±4.4mm, p<0.001) and smaller in SES group 3.1±0.3 mm vs. 3.4±0.5mm, p<0.001) than in CTSS group. At 6 month follow angiographic up, percent stenosis(18.4% vs. 35.5%, p<0.001) and late loss(0.26mm vs. 0.81 mm, p<0.001) of the stented segments were lower in SES group than the CTSS group. In-lesion binary restenosis rate was also lower in SES group but without statistical significance(3.7% vs. 23.5%, p=0.065). Two-year clinical follow-up results were available in 100% and 95% in SES and CTSS group respectively. There were no difference in MACE rates between the 2 groups(3 in SES, 1 in CTSS, p=0.62). There was no death in both groups but 1 late stent thrombosis(556 days after stent implantation) in SES group. The incidence of target lesion revascularization was also not different(2 in SES, 1 in CTSS group, p=NS). Conclusion In large coronary lesions, SES have better angiographic results but there was no difference in clinical results between SES and STSS groups.
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