Author + information
- Hideaki Ota,
- Marco A. Magalhaes,
- Al Fazir Omar,
- Joshua P. Loh,
- Lakshmana K. Pendyala,
- Sa`ar Minha,
- Nevin Baker,
- Ricardo Orlando Escarcega,
- Wenjie Tian,
- Rebecca Torguson,
- Fang Chen,
- Lowell F. Satler,
- William O. Suddath,
- Augusto Pichard and
- Ron Waksman
Strategies comparison for bare-metal stent (BMS) in stent restenosis (ISR) treatment remains not adequately tested. We hypothesized that the second generation everolimus-eluting stent (EES) for the treatment of BMS-ISR is associated with improved outcomes compared to first generation sirolimus-eluting stent (SES) or paclitaxel-eluting stent (PES).
Patients with BMS-ISR undergoing target lesion revascularization (TLR) were grouped according to the additional stent implanted into EES, PES, or SES groups. The end point was MACE composed by all-cause death, myocardial infarction (MI), or TLR and the incidence of definite stent thrombosis (ST) at 1 year.
A total of 315 patients with BMS-ISR underwent TLR with EES, SES and PES. The baseline clinical and angiographic parameters were comparable between 3 groups. The incidence of MACE was 13%, 11% and 16% (p=0.58); respectively. The incidence of ST was numerically lower in the EES group compared to SES and PES. (Table) Multivariate Cox regression showed the independent predictors of MACE at 1 year were: number of treated lesions (hazard ratio [HR]: 1.6; 95% confidence interval [CI]: 1.1-2.4) and acute MI ISR presentation (HR: 3.1, 95%CI: 1.1-9.1).
Second generation EES implantation for BMS failure showed similar rates of MACE at 1 year compared to first generation DES. Although not statistically significant, the incidence of cumulative ST was lower in the BMS stent failure treated with EES compared to PES or SES.
|Clinical outcome for 1 year follow up.|
|EES (n=110)||PES (n=63)||SES (n=142)||p value|
|MACE (n; %)||14 (12.8)||10 (15.6)||15 (10.6)||0.58|
|All cause death (n; %)||4 (3.7)||3 (4.7)||6 (4.3)||0.94|
|MI (n; %)||3 (2.8)||4 (6.5)||3 (2.2)||0.34|
|TLR (n; %)||10 (9.3)||6 (9.7)||8 (5.7)||0.47|
|TVR (n; %)||15 (13.9)||7 (11.3)||16 (11.4)||0.81|
|Stent thrombosis (n; %)||1 (0.9)||2 (3.1)||5 (3.5)||0.47|