Abstract 4751: Six-Month Angiographic and One-Year Clinical Results Following Sirolimus-versus Paclitaxel Eluting Stent Implantation in Patients With Chronic Total Occlusions in a Large Single-Center Experience
Background: There are few data available on efficacy and safety of dlug elutig stent (DES) use in patients with coronary chronic total occlusions (CTOs).
Objectives: To evaluate the impact of sirolimus eluting stent (SES) and paclitaxel eluting stent (PES) on 6-month angiographic and 1-year cllinical outcomes in patients with CTOs.
Methods: We conducted prospective, nonrandamized, observational cohort study of 192 consecutive patients underwent succcessful recanalization in CTOs with either SES (n=94) or PES (n=88) from January 1, 2006 to June 9, 2008 at our hospital. We used propensity-score matching to adjust for differences in clinical and procedural risk factors between the two groups. The primary clinical endpoint was the composite of risk-adjusted cardiac death, lesion-related acute myocardial infarction (MI), repeat target-lesion revascularization (TLR), or angiographic documentation of reocclusion at 1 year. The primary angiographic endpoint were in-stent late lumen loss and in-segment binary restenosis assessed using quantitative coronary angiography at 6 months in a propensity-matched population. In 75 SES-treated patients matched to 75 PES-treated patients, the respective rate for the clinical composite endpoint, mortality, MI, and angiographic documentation of reocclusion was 8.5% and 14.8% (P=0.28), 2.5% and 1.7% (P=0.75), 6.3% and 5.2% (P=0.78), and 2.9% versus 7.4% (P=0.45). Whereas the respective rates for TLR was 5.9% versus 20.1% (P=0.03). In-stent late lumen loss was 0.10±0.43 mm in SES-treated patients and 0.49±0.76 mm in PES-treated patients (P=0.004), and the incidence of in-segment binary restenosis was 5.9% versus 20.1%, respectively (P=0.03).
Conclusions: As compared with PES treatment, SES treatment are associated with a signficantly lower incidence of in-segment binary restenosis at 6 months and TLR at 1 year in similar patients with CTOs in a matched population-based study. The rates of the clinical composite endpoint, mortality, MI, and angiographic documentation of reocclusion are similar at 1 year.