Abstract 4560: Hybrid Strategy of Bare Metal Stent With Drug-eluting Stent Implantation versus an Exclusive Drug-eluting Stent for Multivessel Percutaneous Coronary Intervention
Background: Although drug-eluting stents (DES) demonstrate efficacy in reducing the requirement for repeat revascularization, bare metal stents (BMS) continue to show comparable results in subsets of patients and lesions. This study aimed to examine the strategy of hybrid DES and BMS implantation versus exclusive DES placement for patients with multivessel disease who required at least two stents.
Methods: A cohort of 2062 patients who underwent PCI (697 hybrid; 1365 exclusive DES) were followed clinically up to 1 year and the clinical events were recorded and compared. Patients presenting with cardiogenic shock, anemia (hematocrit <25), and bypass graft PCI were excluded. Only patients with at least two stents in two different lesions were analyzed.
Results: Baseline and procedural characteristics were similar. (Table⇓) The exclusive DES group had more African Americans, hypertension, hyperlipidemia, LAD PCI, and angiographic success. The hybrid group had more AMI, higher number of diseased vessels, longer procedure length and length of hospital stay. In-hospital complications and subacute stent thrombosis rates were similar. At 1 year, there was no difference in TVR-MACE, death, MI, and TVR. On multivariate analysis, hybrid PCI was not a predictor of TVR-MACE. (HR, 1.2 [0.9 –1.5], p=0.155) The strongest predictor of TVR-MACE at 1 year was LAD artery disease and African American race (HR, 1.3 [1.0 –1.6], p=0.038) and (HR, 1.4 [1.0 –1.8], p=0.021), respectively. Cumulative stent thrombosis rates at 1 year were similar.
Conclusions: Patients undergoing PCI with a hybrid approach have similar composite in-hospital and 1-year outcomes when compared to the exclusive DES approach. The hybrid stent approach should be considered for patients with multivessel disease since it can reduce the procedure cost.