Abstract 2989: Revascularization Rates In Patients With Multivessel Disease In Northern New England: How Much Better Are Drug Eluting Stents?
Background: The promise of drug eluting stents (DES) is that they decrease revascularization rates (REVASC). This was true in ARTS II which reported a 1 year REVASC of 8.5% for multivessel disease patients receiving DES compared to 22.4% in the ARTS I bare metal stent (BMS) population (RR 0.40, 95%CI 0.30 – 0.54). To what extent these results represent real world experience is unknown.
Methods: From our Northern New England Relational Revascularization Registry of all PCI and CABG procedures, with vital status through 2006, we identified a cohort of patients with multivessel disease undergoing non-emergent PCI using BMS in 2001–2002 (n=1013) and a similar cohort of PCI patients from 2004 –2005 who received DES (n=1011). We compared their 1-year survival and REVASC using Kaplan-Meier survival analysis and Cox proportional-hazards regression to adjust for differences in casemix.
Results: There were small changes in casemix over time. A minority of patients had 3VD (14.0% BMS v 16.8% DES, p=0.08). Culprit vessel PCI was common (52.6% BMS v 49.6% DES, p=0.17). There was no difference in survival by stent type (Figure⇓). At 1 year, the REVASC was significantly lower for DES than BMS (8.9% v 17.4%; adjusted HR 0.49, 95%CI 0.38 – 0.63).
Conclusion: In our real world experience, the use of DES in patients with multivessel disease is associated with a clinically significant lower risk of REVASC than the use of BMS. The magnitude of this benefit is comparable to that reported in ARTS. In addition, there was no adverse effect of DES on survival.