Abstract 914: Incremental Benefit of Drug-Eluting Stents when Used for Proximal Coronary Artery Lesions: A Report from the NHLBI Dynamic Registry
Coronary atherosclerosis affecting proximal coronary artery segments is associated with adverse cardiovascular outcomes. While drug-eluting stents (DES) are known to reduce restenosis in most lesion types compared to bare metal stents (BMS), their effect when used for treatment of proximal coronary lesions (PCL) is not well understood. Accordingly, we sought to investigate the effect of DES compared to BMS on outcomes of proximal coronary lesions treated with PCI. Using data from waves 1–5 of the NHLBI Dynamic Registry, and after excluding left main and vein graft lesions, we identified 7515 patients who underwent PCI with stenting, of whom 3185 were treated for PCL, and 4330 for non-proximal coronary lesions (NPCL). Primary outcomes were death, myocardial infarction (MI), death/MI, and repeat revascularization at 1 year after the index procedure. There were no significant differences in baseline characteristics between patients treated for PCL and NPCL. In both groups, patients receiving DES had a higher prevalence of diabetes (34.1 vs. 27.2), renal disease (4.7 vs. 8.0), and hypertension (64.5 vs. 77.5), when compared to patients receiving BMS (all p<0.0001). There were no significant differences between the two groups in complexity of the lesions, mean reference vessel diameter or angiographic success. The beneficial effect of DES at one year was greater when used to treat PCL compared to NPCL (table⇓). After multivariate adjustment, use of DES for PCL resulted in significant decreases in death/MI [HR, 0.65 (0.47–0.88, p=0.006)], and need for repeat revascularization [HR 0.49 (0.39–0.62, p<0.001)] when compared to BMS. Compared to BMS, use of DES reduces cardiovascular events when used for treatment of both PCL and NPCL. The magnitude of the benefit, however, is greater when these devices are used for proximal coronary lesions.