We sought to compare the clinical outcomes after perctuaneous coronary revascularization of large coronary arteries using drug-eluting (DES) or bare-metal (BMS) stents.Background
Inde novonative coronary lesions with reference diameters of 2.5–3.5 mm, DES reduce target lesion revascularization (TLR) with no increase in death or myocardial infarction (MI). The relative efficacy of DES in larger coronary artery lesions is less certain.Methods
From the prospective Evaluation of Drug-Eluting Stents and Ischemic Events registry, we identified patients undergoing stenting ofde novolesions in native coronary arteries 3.5–5.0 mm in diameter (n= 1,485). In-hospital and 1-year clinical outcomes were compared for BMS (n= 282) and DES (n= 1,203) patients, using propensity stratification to adjust for differences in potential confounding factors.Results
Most patient characteristics were similar for the two groups, but BMS patients were more likely to have been treated in the setting of ST elevation MI, whereas DES patients had more bifurcation lesions, smaller vessels, and longer total stent lengths. In risk-adjusted analyses, the composite endpoint of 1-year death, MI or TLR was similar for BMS and DES (standardized rate: 11.9% vs. 8.5%,P= 0.10). DES was associated with a 62% reduction in the risk of TLR, although the absolute difference in event rates was small (standardized rates 4.6% vs. 1.8%,P= 0.016).Conclusions
Among relatively unselected patients undergoing PCI of large native coronary arteries, use of DES was associated with a modest reduction in rates of TLR, with a neutral effect on other ischemic endpoints.