Impact of stent type on incidence of major adverse cardiac events in large coronary arteries with tubular and diffuse lesions.

BACKGROUND: The aim of this study was to compare 3 year incidence of major adverse cardiac events (MACE) between bare metal stents (BMS) and drug-eluting stents (DES) in large coronary arteries with tubular and diffuse lesions.

METHODS: Seven hundred forty-five consecutive patients (894 lesions) who underwent percutaneous coronary intervention (PCI) on large coronary arteries (3.0, 3.5 and 4 mm) with tubular (10-20 mm length) or diffuse (>20 mm) lesions using BMS or DES at Ekbatan University Hospital, Hamadan, Iran between October 2009 and September 2012 were included. Patients were divided into six groups based on the diameter and length of the stents: 3.0*≤20 mm, 3.0*>20 mm, 3.5*≤20 mm, 3.5*>20 mm, 4.0*≤20 mm and 4.0*>20 mm. Follow-up visits were set at 1, 2, and 3 years after the procedure. Endpoints of the study were MACE including cardiac death, nonfatal MI (due to in-stent thrombosis) and target lesion revascularization (TLR).

RESULTS: Cardiac death occurred in 12 patients (1.7%), (1.8% in BMS vs. 1.2% in DES). The incidence of MACE was significantly higher in 3-mm coronary arteries with diffuse lesions (>20 mm) in BMS group; however, there were no statistically significant difference in the incidence of MACE following PCI with BMS and DES in 3, 3.5 and 4 mm coronary arteries with tubular lesions (≤20 mm) and 3.5 and 4 mm coronary arteries with diffuse lesions.

CONCLUSIONS: Since the incidence of MACEs did not differ significantly between BMS and DES in most sizes, we suggested that PCI with BMS for coronary arteries in the mentioned sizes can be safe and effective. Further randomized clinical trials focusing simultaneously on diameter and the length of stents are required to corroborate this finding.