Abstract 4729: Bare Metal vs. Drug-Eluting Stents for Calcified Lesion: Findings From the NHLBI PCI Dynamic Registry
Background: Calcified coronary lesions present unique technical challenges during percutaneous coronary intervention (PCI) and concern exists whether drug-eluting stents (DES) are effective in the presence of calcium. This question is unanswered given that randomized trials typically exclude this common patient subset.
Methods: We evaluated patients with PCI of a single calcified lesion enrolled across five recruitment waves in the NHLBI Dynamic Registry between 1997 and 2006. Patients were divided into 2 groups based on the stent type- bare metal stents (BMS) and DES. The primary efficacy outcome was repeat revascularization at 1 year and the primary safety outcome was a composite of death and myocardial infarction at 1 year.
Results: Among the 1537 patients included in the analysis, 884 (57%) underwent PCI with BMS and 653 (43%) with DES. DES use was associated with a significant reduction in the risk of primary efficacy outcome (10.0% vs. 15.3%; p=0.003) (Figure⇓) with no significant increase in the risk of primary safety outcome (9.3% vs. 10.5%; p=0.45) when compared to the BMS group. In a propensity adjusted analysis, DES use was associated with a significantly lower risk in repeat revascularization (HR=0.57, 95% CI 0.40 – 0.82; p=0.002) without any increase in primary safety outcome (HR=0.78; 95% 0.53–1.15; p=0.20) compared to BMS group.
Conclusions: In patients with a single calcified coronary lesions, use of DES compared to BMS was associated with significant reduction in the risk of repeat revascularization without any increase in safety endpoint.