Key result
In patients undergoing elective stenting of large coronary arteries, the use of drug-eluting stents significantly reduced the risk of major adverse cardiac events compared to bare-metal stents (OR 0.48).
Why the study?
What are the predictors of major adverse cardiac events following elective percutaneous coronary intervention and stenting of large coronary arteries (≥3.5mm)?
Cohort (n=3,043)
No
What are the predictors of major adverse cardiac events following elective percutaneous coronary intervention and stenting of large coronary arteries (≥3.5mm)?
Effect estimate: OR 0.48 (95% CI 0.28-0.84)
Absolute Event Rate: 1.56% vs 3.05%
p-value: p=0.011
In patients undergoing elective PCI of large coronary arteries (≥3.5mm), the use of drug-eluting stents is associated with significantly lower MACE compared to bare-metal stents, while a history of cerebrovascular accident strongly predicts adverse events.
DES use associated with lower MACE in elective large-vessel PCI; hypothesis-generating and should not yet change practice.
OBJECTIVE: Diameter of the affected coronary artery is an important predictor of restenosis and need for revascularization. In the present study, we investigated the frequency and potential risk factors for major adverse cardiac events following elective percutaneous coronary intervention (PCI) and stenting of large coronary arteries. METHODS: We reviewed the data of elective candidates of PCI on a large coronary artery who presented to our center. Demographic, clinical, angiographic and follow-up data of the eligible patients were retrieved from our databank. The study characteristics were then compared between the patients with and without MACE in order to find out the probable risk factors for MACE in patients with large stent diameter. RESULTS: Data of 3043 patients who underwent single vessel elective PCI with a stent diameter of ≥3.5mm was reviewed. During a median follow up period of 14 months, 64 (2.1%) patients had MACE. TVR was the most common type of MACE that was observed in 29 patients, while 5 patients had cardiac death. Higher serum levels of creatinine, history of cerebrovascular accident (CVA), and use of a drug eluting stent (DES) were significantly associated with MACE. In the multivariate model, history of CVA (odds ratio=5.23, P=0.030) and use of DES (odds ratio=0.048, P=0.011) were the independent predictors of MACE in patients underwent large coronary artery stenting. CONCLUSION: This study showed that prior CVA and the use of BMS were the potential risk factors for MACE in patients who were stented on their large coronary arteries.
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Aghajani et al. (2017) conducted a cohort in Coronary artery disease requiring elective single vessel percutaneous coronary intervention (n=3,043). Drug-eluting stent (DES) vs. Bare-metal stent (BMS) was evaluated on Major adverse cardiac events (cardiac death, nonfatal MI, TLR, or TVR) (OR 0.48, 95% CI 0.28-0.84, p=0.011). In patients undergoing elective stenting of large coronary arteries, the use of drug-eluting stents significantly reduced the risk of major adverse cardiac events compared to bare-metal stents (OR 0.48).
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