Abstract 5988: Can We Reduce the Use of DES without Compromising Efficacy? Results of a Strategy Combining a Simple Selection Process and the Use of Thin Strut Cobalt Chromium Bare Metal Stents
The introduction of drug eluting stents (DES) has been a breakthrough in the prevention of restenosis following PCI. However, the high rates of late stent thrombosis observed with these devices make alternative preventive strategies mandatory. The use of thin struts cobalt chromium (TSCC) bare metal stents has been associated with promising clinical results. We hypothesized that the use of a strategy combining a simple selection of clinical indications and the use of TSCC BM stents could achieve very low restenosis rates without compromising safety. From September 2005 to June 2006, among patients referred for a PCI procedure in our centre, we prospectively selected those in which at least one of the 2 inclusion criteria was met:
de novo coronary lesion not exceeding 20 mm in length;
vessel diameter more than 2.6 mm; and excluded
those with diabetes mellitus unless vessel diameter > 3.5 mm; to undergo implantation of TSCC bare metal stents.
Twelve months follow-up was obtained in all patients. 511 patients; 30% of the total population referred for PCI; matched the selection criterions and were part of the study. Despite the selection process, the study population was at relatively high risk including 22% of patients with a history of MI, 50% with multivessel coronary artery disease and 59% undergoing PCI for an acute coronary syndrome. The procedural success rate was 99.6%. A single stent was implanted in 88% of patients. A peri-procedural myocardial infarction occurred in 7 (1.4 %) patients. Clinically driven TLR and TVR at 12 months were observed in 8 (1.6%) and 13 (2.5%) patients, respectively. Cumulative In stent-thrombosis at 1 and 12 months occurred in 4 (0.08%) and 6 (0.1%) patients, respectively. Our results demonstrate that a simple selection process, applying to 30% of a routine PCI population, combined with the use of TSCC bare metal stents can be associated with a very favourable long-term clinical outcome. The use of TSCC bare metal stents is an attractive alternative to DES in such a population.