Abstract 1145: Drug-Eluting Stents in the Treatment of Intermediate Lesions: Pooled Analysis from 14 Randomized Clinical Trials
Background Treatment of patients with hemodynamically insignificant intermediate coronary stenoses using bare-metal stents (BMS) has not shown to improve clinical outcomes and therefore is not recommended. By minimizing the risk of restenosis and associated clinical events, drug-eluting stents (DES) may change the approach in the management of these patients.
Objective To address short- and long-term safety and efficacy of DES in the treatment of intermediate lesions, we performed a pooled analysis of 14 DES vs. BMS randomized clinical trials and assessed 2-year outcomes of patients with intermediate lesions.
Methods Of the 9,680 lesions treated in 14 trials, 623 lesions (6.4%) were of intermediate severity (diameter stenosis <50% by quantitative angiography). A total of 448 lesions were treated with a DES, while 175 lesions were treated with a BMS.
Results Baseline characteristics were closely matched between the patients treated with DES vs. BMS. Clinical outcomes at 2-year F/U are presented in the table⇓. Patients treated with DES vs. BMS had similar rates of cardiac death, MI and stent thrombosis (ST) but remarkably lower rates of target vessel revascularization (TLR) and target vessel revascularization (TVR), resulting in lower incidence of composite endpoint of cardiac death/MI/TVR.
Conclusions Treatment of intermediate lesions with DES was safe with 96.8% of the patients free from hard clinical endpoints of cardiac death or MI at 2-year F/U. Compared to BMS, DES resulted in a significant reduction in TLR, TVR and composite endpoint of death/MI/TVR without increase in rates of ST.