Abstract 20981: Comparison of Bare-Metal Stents and Drug Eluting Stents in Ostial Coronary Lesions: Findings from the National Heart, Lung, and Blood Institute Dynamic Registry.
Background: Drug-eluting stents (DES) have been shown to be superior to bare-metal stents (BMS) in patients with uncomplicated coronary disease as well as those with “off-label” clinical indications. Whether DES offer additional benefits and are as safe as BMS in complicated lesion subsets has yet to be determined. Furthermore because of unusual anatomic features, blood flow patterns, and lesion morphology of coronary artery disease located at coronary ostia, there are reasons to expect that DES may be less effective in this subset.
Methods: Accordingly, we compared 3-year clinical outcomes based on the use of DES or BMS among 775 like patients enrolled in the National Heart, Lung and Blood Institute Dynamic Registry who had stenting of at least one ostial lesion (BMS only: waves 1–3, 1997–2001; DES: waves 4–5, 2004–2006). Patients who received BMS in waves 4 and 5 were excluded to minimize selection bias.
Results: A total of 439 patients had 464 ostial lesions treated with BMS and 336 patients had 351 ostial lesions treated with DES. DES patients had a higher prevalence of diabetes (39.7% vs. 30.9%, p=0.01). Adjusted 3-year follow-up event rates are shown in the table below and indicate no significant differences for death, MI, or death/MI between the BMS and DES groups. DES group had lower coronary artery bypass graft (CABG) surgery rates on follow-up.
Conclusions: DES use for ostial lesions was not associated with an increased hazard of death, MI or overall rates of repeat revascularization. Interestingly and unexplained, use of DES was associated with lower rates of CABG during follow up. Continued follow-up of this cohort of patients may provide additional insight into the usefulness of DES for ostial lesions.
- © 2010 by American Heart Association, Inc.