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Deployment of drug-eluting stents for isolated proximal lad disease is associated with lower major adverse cardiac events and no increase in stent thrombosis when compared with bare metal stents: A 5-year observational cohort study

Authors

  • Daniel A. Jones MD,

    1. Department of Cardiology, Barts and the London NHS Trust, London, United Kingdom
    2. Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, United Kingdom
    3. NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, United Kingdom
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  • Krishnaraj S. Rathod MD,

    1. Department of Cardiology, Barts and the London NHS Trust, London, United Kingdom
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  • Sean Gallagher MD,

    1. Department of Cardiology, Barts and the London NHS Trust, London, United Kingdom
    2. NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, United Kingdom
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  • Roshan Weerackody MD,

    1. Department of Cardiology, Barts and the London NHS Trust, London, United Kingdom
    2. NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, United Kingdom
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  • Charles J. Knight MD,

    1. Department of Cardiology, Barts and the London NHS Trust, London, United Kingdom
    2. Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, United Kingdom
    3. NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, United Kingdom
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  • Martin T. Rothman MD,

    1. Department of Cardiology, Barts and the London NHS Trust, London, United Kingdom
    2. NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, United Kingdom
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  • Anthony Mathur MD, PhD,

    1. Department of Cardiology, Barts and the London NHS Trust, London, United Kingdom
    2. Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, United Kingdom
    3. NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, United Kingdom
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  • Ajay K. Jain MD,

    1. Department of Cardiology, Barts and the London NHS Trust, London, United Kingdom
    2. NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, United Kingdom
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  • Adam D. Timmis MD,

    1. Department of Cardiology, Barts and the London NHS Trust, London, United Kingdom
    2. NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, United Kingdom
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  • Andrew Wragg MD, PhD

    Corresponding author
    1. Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, United Kingdom
    2. NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, United Kingdom
    • Department of Cardiology, Barts and the London NHS Trust, London, United Kingdom
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  • Conflict of interest: Nothing to report.

Correspondence to: Andrew Wragg, MD, PhD, Department of Cardiology, London Chest Hospital, Bonner Road, Bethnal Green, London E2 9JX, United Kingdom. E-mail: andrew.wragg@bartsandthelondon.nhs.uk

Abstract

Background

Drug-eluting stents (DES) may be associated with an increased risk of late stent thrombosis (ST) compared with bare metal stents (BMS). We compared major adverse cardiac events (MACE) and long term all cause mortality in patients with isolated proximal LAD disease treated with DES or BMS.

Method and Results

This study of 1653 patients with isolated proximal LAD disease, includes 643 treated with BMS and 1010 treated with DES. All patients received standard dual antiplatelet treatment. MACE after 5 years were less frequent in DES compared with BMS (12.1% 95% CI 9.3–14.2 versus 21.3% 95% CI: 16.9–25.1, P < 0.0001), driven largely by a decreased rate of both target vessel and lesion revascularization (TVR: 6.3%, 95% CI 4.0–7.5% versus 14.7%, 95% CI 11.0–17.3%, P < 0.0001, TLR: (5.3%, 95% CI 3.2–7.1% versus 13.2%, 95% CI 9.8.0–15.4%, P < 0.0001). There was no difference in the rate of death, myocardial infarction, or CVA. Incidence of stent thrombosis was also comparable (1.2% 95% CI: 0.6–2.6% versus 1.1% 95% CI: 0.6–2.5%, P = 0.8). Adjusted Cox analysis confirmed a decreased risk of MACE for DES compared with BMS 0.55 (95% confidence intervals 0.41–0.73) with no difference in the hazard of all cause mortality (HR: 1.04 95% CI: 0.67–1.61).

Conclusion

When treating proximal LAD disease, use of DES was associated with a lower MACE rate than BMS, with no differences in the incidence of stent thrombosis, myocardial infarction or 5 year all cause mortality. Our data suggests that despite the adverse prognostic correlates of proximal LAD disease, DES deployment in this location is both safe and clinically more effective than BMS. © 2012 Wiley Periodicals, Inc.

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