Abstract 4507: MASTER-DES: The Atherosclerotic Lesion, Not The Stent Type Determines Outcome
Hypothesis: In MASTER-DES, the prospective MArburg STEnt Registry on Drug Eluting Stents we examined the hypothesis if with the use drug eluting stents (DES) the lesion type has become unimportant for the longterm prognosis.
Patients and Methods: We analysed restenosis rates and MACE over 3 consecutive years of 1775 stent implantations (78% male, age 32–92 y). 1433 bare metal stents (BMS) (Coroflex, n=787; Coroflex Blue, n= 646 (B.Braun Co)) were compared to 342 DES (Coroflex Please, n=104 (B.Braun Co),Taxus Liberte’, n=167; Taxus Express, n=71 (Boston Scientific). Demographic variables were comparable with the exception of smokers being more frequent in the BMS (23% vs 16%, p<0,006) and diabetics (31% vs 41%, p<0,001) and pts with previous interventions (43% vs15%, p<0,001) being overrepresented in the DES cohort. MACE was defined as myocardial infarction a/o cardiovascular death or restenosis requiring reintervention. Data are based a 6 month routine coronary reangiography for all patients and on clinical follow-up examinations after 6, 12 and 24 months. Double platelet inhibition was routinely administered for at least 1 months in BMS and 6 –12 months in DES pts.
Results: After 6 months MACE in DES when compared to BMS pts was less frequent (p<0,001). Coroflex Please stents demonstrated a lower MACE/restenosis rate than the Taxus stents (8% vs 11%). Already at this stage the lesion type demonstrated its dominant influence on MACE. In type C lesions there was an advantage for DES. After 18 months MACE-curves of DES and BMS had merged and the lesion morphology and not the stent type determined MACE (Table⇓). Type C lesions demonstrated the highest MACE rate (62%) when compared to B (42%) and A (20%) morphologies.
Conclusion: In the real world reinterventions due to restenosis and MACE are more frequent than in randomized trials. After 18 months of follow-up MACE is no longer determined by the stent type but the lesion morphology.