Abstract 4561: Hybrid Strategy for Stent Treatment for Multivessel Coronary Artery Disease
Introduction. The ideal method to treat patients (pts) with multivessel coronary artery disease (CAD) currently remains unclear. Combined drug eluting stents (DES) for complex lesions and bare-metal stents (BS) for simple coronary stenoses might be an alternative. To test the efficacy of this strategy, we designed a prospective comparative study where pts with 2-or 3-vessel CAD were randomly assigned to be treated with DES (Group I) or to combine DES for complex lesions and BS for the simpler stenoses (Group II). Those lesions with a higher restenosis rate (chronic total occlusion, bifurcation, long lesions, small vessels or in-stent restenosis) were considered as complex lesions.
Methods. From Oct/06 to Dec/08 we studied 592 consecutive pts, with 2- or 3-vessel CAD who were treated following this strategy. Of these, 352 were excluded from randomization due to: no primary success (n=8), all treated lesions were simple (group a; n=98), all treated lesions were complex (group b; n=193) or pts had associated comorbidities (group c; n=53). As a results, 240 eligible pts were randomized, in a 1 to 2 fashion, to be part of Group I (n=80) or Group II (n=160). We treated all 186 lesions in Group I and 181 complex lesions in Group II pts with DES; 156 additional simple stenoses in Group II were treated with BS. All major adverse events (MACE) were recorded (mortality, stent thrombosis (ST), acute myocardial infarction (AMI), or target vessel revascularization (TVR).
Results. One-Month MACE was observed in 3 pts (4%) in Group I and in 1 pt (1%) in Group II (ns). Late-onset MACE occurred in 8 pts (10%) in Group I and in 18 pts (11%) in Group II (ns). There were no significant differences among groups in the type of MACE: initial or late mortality (5% vs 4%), ST (0% vs 1%), AMI (1% vs 1%), or TVR (4% vs 4%). Regarding the excluded groups, total MACE were slightly higher than in the study groups: 14% in group a pts, 15% in group b pts and 17% in group c pts.
Conclusions: A hybrid combination of DES for complex lesions and BS for favourable stenoses in pts with multi-vessel CAD seems to provide similar results to those observed in pts where all lesions are treated with DES. Total MACE are similar at a mean of 12-month evaluation with a lower initial procedure cost.