Heart and Vessels

, Volume 31, Issue 5, pp 635–642 | Cite as

Short- and long-term benefits of drug-eluting stents compared to bare metal stents even in treatment for large coronary arteries

  • Taiji Yoshida
  • Kenji Sakata
  • Yutaka Nitta
  • Tomio Taguchi
  • Bunji Kaku
  • Shoji Katsuda
  • Masaya Shimojima
  • Tadatsugu Gamou
  • Takuya Nakahashi
  • Tetsuo Konno
  • Masa-aki Kawashiri
  • Masakazu Yamagishi
  • Kenshi Hayashi
Original Article

Abstract

Although drug-eluting stents (DES) for percutaneous coronary intervention (PCI) have dramatically reduced the incidence of in-stent restenosis, their deployment for large-size coronary lesions is still controversial because of problems such as late in-stent thrombosis and late catch-up in DES. We aimed to evaluate the long-term outcome beyond 2 years of bare metal stents (BMS) as compared with DES in large vessels. Consecutive 228 patients who underwent PCI with large-size stents (>3.5 mm in diameter) in our hospital were enrolled in this study. The end points of this study are target lesion revascularization (TLR) and occurrence of major adverse cardiac events (MACE) for subject patients. We analyzed 183 patients (152 men, mean age 65.8 ± 10.5 years) whose outcome could be followed up for at least 2 years. At the first 8-month follow-up, clinically driven TLR rate was significantly higher in patients who received BMS than those who received DES (17.2 vs. 2.2 %, p < 0.05), although the rate of TLR was not different between the 2 groups beyond 8 months. Thus, overall rate of TLR was higher in BMS than in DES (22.7 vs. 5.4 %, p < 0.05). Under these conditions, the higher rate of TLR for BMS was observed in simple as well as complex lesions with or without diabetes, although there were no significant differences in MACE between BMS and DES. Multivariate analysis showed that BMS was an only independent factor of TLR at the 8 month follow-up period [p = 0.004, odds ratio 9.58, 95 % confidence interval (2.10–43.8)]. These results demonstrate that the rate of in-stent restenosis in large-size coronary lesions was transiently higher in the first 8 months for patients implanted with BMS compared with DES in which no in-stent thrombosis and TLR beyond 2 years were observed. We suggest using the DES even in large-size coronary lesions in terms of short- and long-term outcomes.

Keywords

Coronary intervention Drug-eluting stent Bare metal stent Target lesion revascularization Long-term prognosis 

Supplementary material

380_2015_655_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 19 kb)

References

  1. 1.
    Morice MC, Serruys PW, Sousa JE, Fajadet J, Ban Hayashi E, Perin M, Colombo A, Schuler G, Barragan P, Guagliumi G, Molnàr F, Falotico R (2002) A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. N Engl J Med 346:1773–1780CrossRefPubMedGoogle Scholar
  2. 2.
    Moses JW, Leon MB, Popma JJ, Fitzgerald PJ, Holmes DR, O’Shaughnessy C, Caputo RP, Kereiakes DJ, Williams DO, Teirstein PS, Jaeger JL, Kuntz RE (2003) Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 349:1315–1323CrossRefPubMedGoogle Scholar
  3. 3.
    Stone GW, Ellis SG, Cox DA, Hermiller J, O’Shaughnessy C, Mann JT, Turco M, Caputo R, Bergin P, Greenberg J, Popma JJ, Russell ME (2004) A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med 350:221–231CrossRefPubMedGoogle Scholar
  4. 4.
    Uchiyama K, Ino H, Hayashi K, Fujioka K, Takabatake S, Yokawa J, Namura M, Mizuno S, Tatami R, Kanaya H, Nitta Y, Michishita I, Hirase H, Ueda K, Aoyama T, Okeie K, Haraki T, Mori K, Araki T, Minamoto M, Oiwake H, Konno T, Sakata K, Kawashiri M, Yamagishi M, Heart Research Group of Kanazawa (2011) Impact of severe coronary disease associated or not associated with diabetes mellitus on outcome of interventional treatment using stents: results from HERZ (Heart Research Group of Kanazawa) analyses. J Int Med Res 39:549–557CrossRefPubMedGoogle Scholar
  5. 5.
    Mehran R, Dangas G, Abizaid AS, Mintz GS, Lansky AJ, Satler LF, Pichard AD, Kent KM, Stone GW, Leon MB (1999) Angiographic patterns of in-stent restenosis: classification and implications for long-term outcome. Circulation 100:1872–1878CrossRefPubMedGoogle Scholar
  6. 6.
    Elezi S, Dibra A, Mehilli J, Pache J, Wessely R, Schömig A, Kastrati A (2006) Vessel size and outcome after coronary drug-eluting stent placement: results from a large cohort of patients treated with sirolimus- or paclitaxel-eluting stents. J Am Coll Cardiol 48:1304–1309CrossRefPubMedGoogle Scholar
  7. 7.
    Wykrzykowska JJ, Serruys PW, Onuma Y, de Vries T, van Es GA, Buszman P, Linke A, Ischinger T, Klauss V, Corti R, Eberli F, Wijns W, Morice MC, di Mario C, van Geuns RJ, Juni P, Windecker S (2009) Impact of vessel size on angiographic and clinical outcomes of revascularization with biolimus-eluting stent with biodegradable polymer and sirolimus-eluting stent with durable polymer the LEADERS trial substudy. JACC Cardiovasc Interv 2:861–870CrossRefPubMedGoogle Scholar
  8. 8.
    Ardissino D, Cavallini C, Bramucci E, Indolfi C, Marzocchi A, Manari A, Angeloni G, Carosio G, Bonizzoni E, Colusso S, Repetto M, Merlini PA (2004) Sirolimus-eluting versus uncoated stents for prevention of restenosis in small coronary arteries: a randomized trial. JAMA 292:2727–2734CrossRefPubMedGoogle Scholar
  9. 9.
    Schampaert E, Cohen EA, Schlüter M, Reeves F, Traboulsi M, Title LM, Kuntz RE, Popma JJ (2004) The Canadian study of the sirolimus-eluting stent in the treatment of patients with long de novo lesions in small native coronary arteries (C-SIRIUS). J Am Coll Cardiol 43:1110–1115CrossRefPubMedGoogle Scholar
  10. 10.
    Puymirat E, Mangiacapra F, Peace A, Sharif F, Conte M, Bartunek J, Vanderheyden M, Wijns W, de Bruyne B, Barbato E (2011) Long-term clinical outcome in patients with small vessel disease treated with drug-eluting versus bare-metal stenting. Am Heart J 162:907–913CrossRefPubMedGoogle Scholar
  11. 11.
    McFadden EP, Stabile E, Regar E, Cheneau E, Ong AT, Kinnaird T, Suddath WO, Weissman NJ, Torguson R, Kent KM, Pichard AD, Satler LF, Waksman R, Serruys PW (2004) Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy. Lancet 364:1519–1521CrossRefPubMedGoogle Scholar
  12. 12.
    Daemen J, Wenaweser P, Tsuchida K, Abrecht L, Vaina S, Morger C, Kukreja N, Jüni P, Sianos G, Hellige G, van Domburg RT, Hess OM, Boersma E, Meier B, Windecker S, Serruys PW (2007) Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study. Lancet 369:667–678CrossRefPubMedGoogle Scholar
  13. 13.
    Kastrati A, Mehilli J, Pache J, Kaiser C, Valgimigli M, Kelbaek H, Menichelli M, Sabaté M, Suttorp MJ, Baumgart D, Seyfarth M, Pfisterer ME, Schömig A (2007) Analysis of 14 trials comparing sirolimus-eluting stents with bare-metal stents. N Engl J Med 356:1030–1039CrossRefPubMedGoogle Scholar
  14. 14.
    Kimura T, Morimoto T, Nakagawa Y, Tamura T, Kadota K, Yasumoto H, Nishikawa H, Hiasa Y, Muramatsu T, Meguro T, Inoue N, Honda H, Hayashi Y, Miyazaki S, Oshima S, Honda T, Shiode N, Namura M, Sone T, Nobuyoshi M, Kita T, Mitsudo K (2009) Antiplatelet therapy and stent thrombosis after sirolimus-eluting stent implantation. Circulation 119:987–995CrossRefPubMedGoogle Scholar
  15. 15.
    Steinberg DH, Mishra S, Javaid A, Slottow TL, Buch AN, Roy P, Okabe T, Smith KA, Torguson R, Xue Z, Pichard AD, Satler LF, Kent KM, Suddath WO, Waksman R (2007) Comparison of effectiveness of bare metal stents versus drug-eluting stents in large (> or =3.5 mm) coronary arteries. Am J Cardiol 99:599–602CrossRefPubMedGoogle Scholar
  16. 16.
    Yan BP, Ajani AE, New G, Duffy SJ, Farouque O, Shaw J, Sebastian M, Lew R, Brennan A, Andrianopoulos N, Reid C, Clark DJ (2008) Are drug-eluting stents indicated in large coronary arteries? Insights from a multi-centre percutaneous coronary intervention registry. Int J Cardiol 130:374–379CrossRefPubMedGoogle Scholar
  17. 17.
    Yang YJ, Kang S, Xu B, Chen JL, Qiao SB, Qin XW, Yao M, Chen J, Wu YJ, Liu HB, Yuan JQ, You SJ, Li JJ, Dai J, Gao RL (2008) Short- and long-term outcomes of single bare metal stent versus drug eluting stent in nondiabetic patients with a simple de novo lesion in the middle and large vessel. J Transl Med 6:42CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Na JO, Kim JW, Choi CU, Choi UJ, Shin SY, Lim HE, Kim EJ, Rha SW, Park CG, Seo HS, Oh DJ (2009) Bare-metal stents versus drug-eluting stents in large (≥3.5 mm) single coronary artery: angiographic and clinical outcomes at 6 months. J Cardiol 54:108–114CrossRefPubMedGoogle Scholar
  19. 19.
    Hsieh MJ, Chen CC, Chang SH, Wang CY, Lee CH, Lin FC, Chang CJ, Hsieh IC (2013) Long-term outcomes of drug-eluting stents versus bare-metal stents in large coronary arteries. Int J Cardiol 168:3785–3790CrossRefPubMedGoogle Scholar
  20. 20.
    Chan CY, Vlachos H, Selzer F, Mulukutla SR, Marroquin OC, Abbott DJ, Holper EM, Williams DO (2014) Comparison of drug-eluting and bare metal stents in large coronary arteries: findings from the NHLBI dynamic registry. Catheter Cardiovasc Interv 84:24–29CrossRefPubMedGoogle Scholar
  21. 21.
    Kawashiri MA, Sakata K, Uchiyama K, Konno T, Namura M, Mizuno S, Tatami R, Kanaya H, Nitta Y, Michishita I, Hirase H, Ueda K, Aoyama T, Okeie K, Haraki T, Mori K, Araki T, Minamoto M, Oiwake H, Ino H, Hayashi K, Yamagishi M (2014) Impact of lesion morphology and associated procedures for left main coronary stenting on angiographic outcome after intervention: sub-analysis of Heart Research Group of Kanazawa, HERZ, Study. Cardiovasc Interv Ther 29:117–122CrossRefPubMedGoogle Scholar
  22. 22.
    Nakamura M, Yamagishi M, Ueno T, Hara K, Ishiwata S, Itoh T, Hamanaka I, Wakatsuki T, Sugano T, Kawai K, Kimura T (2013) Current antiplatelet therapy for Japanese patients with ST elevation acute myocardial infarction: J-AMI registry. Cardiovasc Interv Ther 28:162–169CrossRefPubMedGoogle Scholar
  23. 23.
    Smith SC Jr, Dove JT, Jacobs AK, Kennedy JW, Kereiakes D, Kern MJ, Kuntz RE, Popma JJ, Schaff HV, Williams DO, Gibbons RJ, Alpert JP, Eagle KA, Faxon DP, Fuster V, Gardner TJ, Gregoratos G, Russell RO, Smith SC Jr (2001) ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines)—executive summary: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty) endorsed by the Society for Cardiac Angiography and Interventions. Circulation 103:3019–3041CrossRefPubMedGoogle Scholar
  24. 24.
    Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, van Es GA, Steg PG, Morel MA, Mauri L, Vranckx P, McFadden E, Lansky A, Hamon M, Krucoff MW, Serruys PW, Academic Research Consortium (2007) Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 115:2344–2351CrossRefPubMedGoogle Scholar
  25. 25.
    Hansen KW, Kaiser C, Hvelplund A, Soerensen R, Madsen JK, Jensen JS, Pedersen SH, Eberli FR, Erne P, Alber H, Pfisterer M, Galatius S, BASKET PROVE Investigators (2013) Improved 2-year outcomes after drug-eluting versus bare-metal stent implantation in women and men with large coronary arteries: importance of vessel size. Int J Cardiol 169:29–34CrossRefPubMedGoogle Scholar
  26. 26.
    Taguchi I, Yoneda S, Abe S, Toyoda S, Nasuno T, Nishino S, Kageyama M, Tokura M, Ogawa M, Node K, Inoue T (2014) The late-phase inflammatory response after drug-eluting stent implantation. Heart Vessels 29:213–219CrossRefPubMedGoogle Scholar
  27. 27.
    Tada H, Kawashiri MA, Sakata K, Takabatake S, Tsubokawa T, Konno T, Hayashi K, Uchiyama K, Ino H, Yamagishi M (2012) Impact of out-stent plaque volume on in-stent intimal hyperplasia: results from serial volumetric analysis with high-gain intravascular ultrasound. Int J Cardiol 12:235–239CrossRefGoogle Scholar
  28. 28.
    Doyle B, Rihal CS, O’Sullivan CJ, Lennon RJ, Wiste HJ, Bell M, Bresnahan J, Holmes DR Jr (2007) Outcomes of stent thrombosis and restenosis during extended follow-up of patients treated with bare-metal coronary stents. Circulation 116:2391–2398CrossRefPubMedGoogle Scholar
  29. 29.
    Hasegawa K, Tamai H, Kyo E, Kosuga K, Ikeguchi S, Hata T, Okada M, Fujita S, Tsuji T, Takeda S, Fukuhara R, Kikuta Y, Motohara S, Ono K, Takeuchi E (2006) Histopathological findings of new in-stent lesions developed beyond 5 years. Catheter Cardiovasc Interv 68:554–558CrossRefPubMedGoogle Scholar
  30. 30.
    Tanaka S, Noda T, Iwama M, Tanihata S, Kawasaki M, Nishigaki K, Minagawa T, Watanabe S, Minatoguchi S (2013) Long-term changes in neointimal hyperplasia following implantation of bare metal stents assessed by integrated backscatter intravascular ultrasound. Heart Vessels 28:415–423CrossRefPubMedGoogle Scholar

Copyright information

© Springer Japan 2015

Authors and Affiliations

  • Taiji Yoshida
    • 1
    • 2
  • Kenji Sakata
    • 2
  • Yutaka Nitta
    • 1
  • Tomio Taguchi
    • 1
  • Bunji Kaku
    • 1
  • Shoji Katsuda
    • 1
  • Masaya Shimojima
    • 2
  • Tadatsugu Gamou
    • 2
  • Takuya Nakahashi
    • 2
  • Tetsuo Konno
    • 2
  • Masa-aki Kawashiri
    • 2
  • Masakazu Yamagishi
    • 3
  • Kenshi Hayashi
    • 2
  1. 1.Department of CardiologyToyama Red Cross HospitalToyamaJapan
  2. 2.Division of Cardiovascular MedicineKanazawa University Graduate School of MedicineKanazawaJapan
  3. 3.Division of Cardiovascular MedicineKanazawa University Graduate School of MedicineKanazawaJapan

Personalised recommendations