To the Editor: In recent years, the introduction (1) of drugeluting stents (DES) during percutaneous coronary interventions (PCI) has been one of the major breakthroughs in interventional procedures. Several observational and randomized studies have shown a significantly lower restenosis rate with DES compared with bare-stent technology. Sirolimus-eluting stents (SES) or paclitaxel-eluting stents (PES) stents also substantially reduce the need for repeat revascularization procedures compared with standard stent technology (2-5). However, late safety outcome of these new devices is not well established. Late stent thrombosis, not seen in the first series of studies (1-5), has been recently reported (6,7) and was associated with major adverse cardiac events. Even though a meta-analysis of randomized studies and registries confirmed the efficacy and safety of DES (8), these studies were not powered to detect any increase in late-stent thrombosis. Furthermore, in those studies, stent thrombosis (SET) was not equal and appropriately defined; more importantly, none of the cited studies included SET as a prespecified end point. Therefore, we sought to investigate the incidence of SET in a DES population (9) included prospectively in the multicenter and controlled Argentine Randomized Trial of Coronary Stents versus Bypass Surgery (ERACI III) trial.From June 2002 to December 2004, 225 patients treated with PCI and DES in five centers in Buenos Aires meeting the clinical and angiographic criteria of the ERACI II trial (10) were prospectively and consecutively included in the ERACI III study. The inclusion criteria of the ERACI studies were previously reported (10). All patients had multiple-vessel disease and were treated with at least one DES, SES, or PES in equal proportion (Cypher, Cordis, Johnson and Johnson, Miami Lakes, Florida; and TAXUS, Boston Scientific Corp., Natick, Massachusetts). The end points of the ERACI III study were to compare major and minor cardiac adverse events at one, two, three, and five years of follow-up between the ERACI III DES patients (n ϭ 225) and ERACI II PCI (n ϭ 225) and ERACI II CABG study patients (n ϭ 225). Comparison of coronary stent thrombosis (SET) between the ERACI III and ERACI II PCI study arm (bare stent) was one of the secondary end points of this study. The purpose of this study was to analyze the incidence of SET during the first 30 days and during follow-up in the ERACI III study patients.Stent thrombosis was defined as follows: 42 LM ϭ left main coronary artery.

Abciximab plus IRA stenting should be considered the routine reperfusion strategy in patients with AMI undergoing primary percutaneous mechanical revascularization, especially in high-risk patients.

In patients with multivessel CVD, the initial advantage for PCI with DES over CABG observed at 1 year was not apparent by 3 years. Furthermore, despite continued lower incidence of MACCE, initial advantage over BMS appeared to decrease with time. LST occurred more frequent in DES-treated patients.

In recent years an angiographic score was introduced in clinical practice to stratified different levels of risk after percutaneous coronary interventions (PCI) with drug eluting stents. The SYNTAX score (SS) classified patients in three different risk levels and was included in revascularization guidelines that patients allocated with low SS could be equally treated with either PCI or CABG, whereas those with intermediate or high SS were better off with CABG. However, using original SS each coronary lesion with a diameter stenosis ≥50% in vessels ≥1.5 mm was scored. In ERACI IV registry we used a revascularization strategy during PCI where operators were advised to only treat lesions≥than 70% in a≥2.0 mm reference vessel; therefore, no intermediate lesions should be treated, and severe stenosis in vessels<2.0 mm was discouraged as well. If we recalculated SS using the above-mentioned operators' advices all intermediate lesions were not scored, and severe stenosis in vessels<2.0 mm were excluded for the analysis, including bifurcations, trifurcations and chronic total occlusions; after this new scoring, the original SS dropped significantly which is in accordance with the goal of complete functional revascularization strategy of the ERACI IV study and the low one year adverse events of such study. In conclusion, if we performed an SS scoring, only severe stenosis in vessels with a reference diameter ≥2.0 mm would allow a more rational assessment of coronary anatomy, and the use of a more conservative PCI strategy.

This registry showed that 2DES in MVD has a remarkable low incidence of MACCE in unadjusted and adjusted analysis. © 2016 Wiley Periodicals, Inc.