Abstract 20948: Comparison of Bare-Metal Stents and Drug Eluting Stents for Bifurcation Coronary Lesions: Findings from the National Heart, Lung, and Blood Institute Dynamic Registry.
Background: Bifurcation lesions (BL) have been associated with increased rates of lesion recurrence and untoward events. Whether drug-eluting stents (DES) provide a benefit over bare-metal stents (BMS) in patients with BL in the setting of unrestricted use is unknown. Accordingly, we compared 3-year clinical outcomes of like patients undergoing BL stenting with either BMS or DES in the NHLBI Dynamic Registry.
Methods: 1101 patients in the registry underwent stenting of ≥ 1 BL and were divided into 2 groups: BMS Group (n=705) from Waves 1–3 (1997–2001) and DES Group (n=396) from Waves 4–5 (2004–2006). Patients were selected from different enrollment waves in order to minimize selection bias.
Results: Among BL patients, those treated with DES had higher prevalence of diabetes (34.7% vs. 24.7%, p<0.001), severe concomitant co-morbid conditions (40.9% vs 31.6%, p=0.002), renal failure (9.9% vs. 4.7%, p<0.001), and cerebrovascular disease (8.6% vs. 5.6%, p=0.02) than BMS patients. Procedural success was high and similar in both groups (98.0%: BMS and 99.5%: DES). Three-year adjusted outcomes are summarized in the table below.
Conclusions: Despite having a higher prevalence of comorbid conditions, three-year hazard of repeat revascularization was significantly lower in BL patients treated with DES, compared to BMS treated patients, without increased hazard of death or MI. These findings support the usefulness of DES in bifurcation coronary lesions.
- © 2010 by American Heart Association, Inc.