Cobalt Chromium Coronary Stents and Drug-Eluting Stents in Real Practice

Abstract

SummaryCobalt chromium stents (CCS) are seldom compared to drug-eluting stents (DES) for coronary intervention in published clinical trials. We evaluated the daily usage patterns of CCS in comparison to DES unconstrained by eligibility criteria. We compared consecutive patients (n = 303) with de novo lesions treated exclusively with a CCS to 432 patients treated exclusively with a DES. Patients in the CCS group were older, frequently had heart failure, renal failure, prior coronary balloon angioplasty, prior stroke, more comorbidities, and more multivessel disease than the DES group. The DES group had longer and more type C and left anterior descending (LAD) coronary artery lesions. The in-hospital major adverse cardiac events (MACE; death, myocardial infarction, stroke and target lesion revascularization (TLR)) were similar. At 6 months, the cumulative rate of MACE was 12.9% in the CCS group and 5.6% in the DES group (P < 0.001), and this was driven by TLR. The rates of stent thrombosis were similar in CCS (0.9%) and DES (1.0%) patients.In conclusion, the CCS were used in clinically higher risk patients, while DES were used in more severely diseased coronary arteries. Drug-eluting stent use resulted in lower rates of clinically driven repeat revascularization with similar rates of death, MI, stroke, and stent thrombosis. (Int Heart J 2010; 51: 231-237) Key words: Stents, Cobalt chromium, Drug-eluting, Restenosis T he rates of restenosis and major adverse cardiac events (MACE) have both been demonstrated to be significantly reduced with the use of drug-eluting stents (DES) compared with bare-metal stents (BMS) in a broad variety of studies and trials.1-6) The same trials could not demonstrate any differences in mortality or acute myocardial infarction (AMI) rates. Therefore, the reported clinical benefit of DES is entirely due to the highly significant reduction in the need for repeated interventions. However, concerns about late events associated with DES have come to light, suggesting that the indiscriminate use of DES is actually not advisable. [7][8][9] Moreover, there is controversy regarding the advantage of using DES over BMS in terms of clinical outcome for short lesions and relatively large vessels (≥ 3.0 mm). 6) Also, exploring how physicians decide which stent category to use for different uncontrolled clinical and angiographic varieties, and how this impacts clinical outcome in real practice represents is important. And finally, in the majority of the randomized DES trials, the BMS used were not the most up-to-date in terms of stent design and technology. A study involving last-generation BMS, essentially cobalt chromium stents (CCS), showed lower revascularization rates. This famous randomized trial showed that the use of DES compared to CCS in all patients has no clinical benefit, including no significant difference in restenosis related target vessel revascularization. 10) However, data regarding such comparisons and the usage patterns in clinical settings are limited in the literature. . Subjects...