Abstract 17985: Longest Available (up to Eight Years) Experience With Drug-Eluting Stents for Non-Selected Complex Patients: Assessing the Independent Predictors of Negative Events in the Desire Registry
Background: Although DES are markedly superior in reducing the need of repeat lesion revascularization when compared to BMS, the very long term outcomes of this novel technology remains relatively unclear, especially in more complex subsets of patients and lesions not initially investigated in controlled RCT.
Methods: The DESIRE registry is a prospective, single-center registry with consecutive patients treated solely with DES between May 2002 and Mar 2010. All subsets of patients and lesions are included in this registry. The primary goal was very long-term occurrence of MACE and stent thrombosis (ST). Patients were clinically evaluated at 1, 6 and 12 months and then annually, up to 8 years (ongoing FU). A multivariate model was built to determine independent predictors of MACE, TLR and ST.
Results: A total of 3,220 patients were included. The mean age was 64 + 11 years. DM was detected in 28.6% and 44.8% presented with acute coronary syndrome. SVG lesions and STEMI pts represented 7% and 12% of the cohort, respectively. Cypher™ was the predominant DES (82.2%). Follow-up was obtained in 98% of the eligible patients (median 3.5 years). Up to seven-year follow-up, 89.6% of the population was free of any MACE. TLR was performed in 3.3% of the patients. Q-wave MI occurred in only 0.7% of these patients and total ST rate was 1.6% (n=42). Independent predictors of MACE were treatment of SVG lesions (HR 1,63; 95% CI, 1.22 to 2.18, p= 0.001), treatment of multivessel disease (HR 1.39; 95% CI, 1.03 to 1.87, p<0.001), residual stenosis (HR 1.3; 95% CI, 1.1 to 1.5, p= 0.034), DM (HR 1.6; 95% CI, 1.1 to 2.2, p= 0.006) and renal insufficiency (HR 1.5; 95% CI, 1.34 to 1.81, p= 0.004).Independent predictors of ST were PCI in the setting of STEMI (HR 3.5; 95% CI, 1.3 to 9.4, p= 0.013), stent length (HR 1.8; 95% CI, 1.09 to 3.02, p=0.023), moderate to severe calcification at lesion site (HR 2.38; 95% CI, 1.34 to 4.23, p=0.003), DM (HR 2.3; 95% CI, 1.8 to 4.7, p<0.001), and, in-stent residual stenosis (HR 1.04; 95% CI, 1.01 to 1.06, p=0.003).
Conclusions: The use of DES in unselected population was associated with very long-term sustained safety and effectiveness with acceptable low rates of adverse clinical events, including ST.
- © 2010 by American Heart Association, Inc.