Coronary artery disease
Impact of Three or More Versus a Single Sirolimus-Eluting Stent on Outcomes in Patients Who Undergo Percutaneous Coronary Intervention

https://doi.org/10.1016/j.amjcard.2005.09.097Get rights and content

This retrospective analysis compared clinical outcomes of patients who underwent stenting with ≥3 sirolimus-eluting stents (SESs) with those who received a single SES. SES (Cypher) implantation for single vessels is proved to be effective and durable, but knowledge regarding the safety and effectiveness of multiple stenting with SESs is currently limited. In total, 929 consecutive patients who received SESs were identified; 63 received ≥3 SESs (multi group) and 866 received 1 SES (single group). The multi group had more non–Q-wave myocardial infarctions (MIs) during the index hospitalization (p = 0.02). At 30-day follow-up, death, Q-wave MI, subacute thrombosis, and major adverse cardiac events were higher in the multi group than in the single group. At 6 months, death, Q-wave MI, target lesion revascularization, and major adverse cardiac events continued to be higher in the multi group. Using multivariate analysis, ≥3 SES implantations, American College of Cardiology/American Heart Association type C lesions, and cardiogenic shock were identified as independent predictors for 6-month major adverse cardiac events. In addition, patients in the multi group had a significantly lower survival rate than patients in the single group (p <0.0001). Patients who required ≥3 SES implantations developed increased periprocedural non–Q-wave MI and worse adverse clinical outcomes at 30 days and 6 months compared with patients who required a single SES implantation. In conclusion, when patients present with multiple coronary lesions, percutaneous coronary intervention with multiple SESs should be undertaken with great caution.

Section snippets

Methods

We retrospectively analyzed patients who underwent PCI with SESs (Cypher, Johnson & Johnson Cordis Corp.) at the Washington Hospital Center (Washington, DC). Since approval of the SES in March 2003 by the Food and Drug Administration, 929 consecutive patients who received SESs were identified; 63 patients received ≥3 SES implantations (multi group) and 866 received a single SES implantation (single group). There were 128 diseased vessels in the multi group and 891 diseased vessels in the single

Results

Baseline clinical and angiographic characteristics are listed in Table 1, Table 2. These characteristics are well balanced between groups. In-hospital complications and 30-day and 6-month clinical outcomes are presented in Table 3. During the index hospitalization, the multi group had significantly higher rates of periprocedural non–Q-wave MI (p = 0.02) than did the single group.

At 30-day follow-up, the multi group had significantly higher rates of death, Q-wave MI, target lesion

Discussion

The present study demonstrates that patients who underwent PCI with ≥3 SES implantations had significantly higher rates of in-hospital non–Q-wave MI and of death, Q-wave MI, target lesion revascularization, target vessel revascularization, and major adverse cardiac events at follow-up than did patients with the same risk profiles who underwent PCI with a single SES implantation. In addition, the multi group had a significantly lower survival rate compared with the single group. Therefore, the

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