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KMID : 0882420150890020192
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Korean Journal of Medicine
2015 Volume.89 No. 2 p.192 ~ p.200
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Comparison of Clinical Outcomes after Implantation of First- and Second-Generation Overlapping Drug-Eluting Stents to Treat Diffuse Long Coronary Lesions
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Oh kyung-Soo
Jeong Myung-Ho
Rhee Jung-Ae
Choi Jin-Su
Lee Doo-Hwan
Kim Jeong-Hun
Park Soo-Hwan
Kim In-Soo
Hyun Dae-Yong
Jeong Yun-Ah
Jeong Hae-Chang
Park Keun-Ho
Sim Doo-Sun
Yoon Hyun-Ju
Kim Kye-Hoon
Park Hyung-Wook
Hong Young-Joon
Ahn Young-Keun
Cho Jeong-Gwan
Park Jong-Chun
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Abstract
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Background/Aims: Despite improved revascularization techniques, the clinical outcomes of patients with diffuse coronary artery lesions after percutaneous coronary intervention are unsatisfactory. However, few studies have compared the efficacy of first- and second-generation drug-eluting stents (DES) in patients with diffuse long coronary artery lesions.
Methods: Between January 2006 and July 2012, 364 patients who were treated with DES for long coronary artery stenosis (> 30 mm) were enrolled in this study and assigned to either Group I (first-generation DES, 62.3 ± 10.4 years, 136 males, n = 183) or Group II (second-generation DES, 64.3 ± 10.7 years, 134 males, n = 181). The incidence of major adverse cardiac events (MACE) was compared between the two groups over 2 years of follow-up, and predictive factors associated with MACE were evaluated through a multivariate analysis.
Results: Although several coronary angiographic characteristics were different between the two groups, most demographic and baseline clinical variables were the same. The cumulative incidence of MACE was significantly higher in Group I than in Group II (25.7 vs. 6.6%; p < 0.001), mainly due to reduced target lesion revascularization (21.9 vs. 2.2%; p < 0.001). According to the results of the multivariate analysis, the use of a paclitaxel-eluting stent (PES) (hazard ratio [HR], 5.168; 95% confidence interval [CI], 2.515-10.617; p < 0.001), decreased left ventricular function (≤ 45%; HR, 3.586; 95% CI, 1.839-6.990; p < 0.001), and diabetes mellitus (HR, 2.984; 95% CI, 1.605-5.548; p < 0.001) were independent contributors to MACE.
Conclusions: For patients with diffuse long coronary artery stenosis, the use of second-generation DES improved the clinical outcome compared with first-generation DES. In addition, the use of a PES, left ventricular dysfunction, and diabetes were predictors of MACE after overlapping stenting.
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KEYWORD
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Drug-eluting stents, Percutaneous coronary intervention
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