Outcomes of small coronary artery stenting with bare‐metal stents versus drug‐eluting stents: Results from the NHLBI dynamic registry

Abstract

Objectives Examine one year outcomes of patients with small coronary arteries in the National Heart, Lung and Blood Institute Dynamic Registry (NHLBI) undergoing drug-eluting stent (DES) vs. bare-metal stent (BMS) placement. Background While randomized trials of DES vs. BMS demonstrate reduced target vessel revascularization, it is unclear if similar outcomes are seen in unselected patients after percutaneous coronary intervention (PCI) for small coronary arteries. Methods Utilizing patients from the NHLBI Registry Waves 1–3 for BMS (1997–2002) and Waves 4–5 for DES (2004 and 2006), demographic, angiographic, in-hospital and one-year outcome data of patients with small coronary arteries treated with BMS (n= 686) vs. DES (n= 669) were evaluated. Small coronary artery was defined as 2.50 – 3.00 mm in diameter. Results Compared to BMS-treated patients, the mean lesion length of treated lesions was longer in the DES treated group (16.7 vs. 13.1 mm, p<0.001) and the mean reference vessel size of attempted lesions was smaller (2.6 vs. 2.7 mm, p<0.001). Adjusted analyses of one year outcomes revealed that DES patients were at lower risk to undergo coronary artery bypass graft surgery (Hazard Ratio [HR] 0.40, 95% Confidence Interval [CI] 0.17–0.95, p=0.04), repeat PCI (HR 0.53, 95% CI 0.35–0.82, p=0.004), and experience the combined major adverse cardiovascular event rate (HR 0.59, 95% CI 0.42–0.83, p=0.002). There was no difference in the risk of death and myocardial infarction (MI) (HR 0.78, 95% CI 0.46–1.35, p=0.38). Conclusions In this real-world registry, patients with small coronary arteries treated with DES had significantly lower rates of repeat revascularization and major adverse cardiovascular events at one year compared to patients treated with BMS, with no increase in the risk of death and MI. These data confirm the efficacy and safety of DES over BMS in the treatment of small coronary arteries in routine clinical practice.

Prospective, multi-center evaluation of a silicon carbide coated cobalt chromium bare metal stent for percutaneous coronary interventions: Two-year results of the ENERGY Registry

“…Our registry, however, showed remarkably good outcomes in patients with small stents, which were slightly superior to the overall ENERGY population. Furthermore, the revascularization rate of 4.1% at 12 months was lower than published results in other cohorts treated with BMS (6.8%-11.2%) [28,33,34] and within range of those treated with DES (3.2% for the SCAAR registry and 4.4% for the NHLBI dynamic registry at Fig. 2.…”

“…Cumulative risks for MACE, all-cause mortality, myocardial infarction, clinically driven target lesion revascularization and definite stent thrombosis. 12 months and 10.3% at 9 months for the PICOLETTO study) [28,33,35]. The most plausible explanation is that complicated small lesions would likely have been treated with DES or left alone originally and therefore were not included in this registry.…”

Selective use of contemporary drug-eluting stents in primary angioplasty for ST-elevation myocardial infarction: pooled analysis of COMFORTABLE AMI and EXAMINATION

“…The benefit over BMS is marked in some patient subgroups and lesion subsets and is less pronounced or absent in others [6][7][8][9][10][11] . Use of multiple stents, vessel diameter and diabetes have long been identified as predictors of restenosis after stent implantation 12 .…”

Outcomes of Overlapping Heterogeneous Drug‐Eluting Stents Versus Homogeneous Drug‐Eluting Stents for Diffuse Lesions in Small Coronary Arteries

“…These findings are in agreement with our study, but the present study differed from previous studies in that it enrolled only patients with small vessel disease who were not just implanted 2 overlapping DES. The principal challenge of stenting small coronary arises from the fact that small vessel size and lesion length continue to be the independent predictors of restenosis and target lesion revascularization even receiving DES though recent studies demonstrated DES used to treat small coronary arteries improved both angiographic and clinical outcomes . However, the available data investigating overlapping DES in small vessel disease are very limited, especially overlapping more than 2 DES in diffuse lesion.…”