Drug-Eluting or Bare-Metal Stents for Left Anterior Descending or Left Main Coronary Artery Revascularization.pdf (2.76 MB)
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Drug-eluting or bare-metal stents for left anterior descending or left main coronary artery revascularization

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journal contribution
posted on 03.06.2022, 13:34 authored by Raffaele Piccolo, Kaare H Bonaa, Orestis Efthimiou, Olivier Varenne, Philip Urban, Christoph Kaiser, Lorenz Räber, Adam de Belder, Wouter Remkes, Arnoud W J Van't Hof, Goran Stankovic, Pedro A Lemos, Tom Wilsgaard, Jörg Reifart, Alfredo E Rodriguez, Expedito E Ribeiro, Patrick WJC Serruys, Alex Abizaid, Manel Sabaté, Robert ByrneRobert Byrne, Jose M de la Torre Hernandez, William Wijns, Giovanni Esposito, Peter Jüni, Stephan Windecker, Marco Valgimigli, Coronary Stent Trialists' (CST) Collaboration

Background

New‐generation drug‐eluting stents (DES) reduce target‐vessel revascularization compared with bare‐metal stents (BMS), and recent data suggest that DES have the potential to decrease the risk of myocardial infarction and cardiovascular mortality. We evaluated the treatment effect of DES versus BMS according to the target artery (left anterior descending [LAD] and/or left main [LM] versus other territories [no‐LAD/LM]).

Methods and Results

The Coronary Stent Trialist (CST) Collaboration gathered individual patient data of randomized trials of DES versus BMS for the treatment of coronary artery disease. The primary outcome was the composite of cardiac death or myocardial infarction. Hazard ratios (HRs) with 95% CIs were derived from a 1‐stage individual patient data meta‐analysis. We included 26 024 patients across 19 trials: 13 650 (52.4%) in the LAD/LM and 12 373 (47.6%) in the no‐LAD/LM group. At 6‐year follow‐up, there was strong evidence that the treatment effect of DES versus BMS depended on the target vessel (P‐interaction=0.024). Compared with BMS, DES reduced the risk of cardiac death or myocardial infarction to a greater extent in the LAD/LM (HR, 0.76; 95% CI, 0.68–0.85) than in the no‐LAD/LM territories (HR, 0.93; 95% CI, 0.83–1.05). This benefit was driven by a lower risk of cardiac death (HR, 0.83; 95% CI, 0.70–0.98) and myocardial infarction (HR, 0.74; 95% CI, 0.65–0.85) in patients with LAD/LM disease randomized to DES. An interaction (P=0.004) was also found for all‐cause mortality with patients with LAD/LM disease deriving benefit from DES (HR, 0.86; 95% CI, 0.76–0.97).

Conclusions

As compared with BMS, new‐generation DES were associated with sustained reduction in the composite of cardiac death or myocardial infarction if used for the treatment of LAD or left main coronary stenoses.

Registration

URL: https://www.crd.york.ac.uk/PROSPERO; Unique identifier: CRD42017060520.

Funding

Department of Cardiology at Bern University Hospital, Bern, Switzerland

History

Comments

The original article is available at https://www.ahajournals.org/

Published Citation

Piccolo R. et al. Drug-eluting or bare-metal stents for left anterior descending or left main coronary artery revascularization. J Am Heart Assoc. 2021;10(20):e018828

Publication Date

8 October 2021

PubMed ID

34622669

Department/Unit

  • School of Pharmacy and Biomolecular Sciences

Research Area

  • Vascular Biology

Publisher

Wiley-Blackwell

Version

  • Published Version (Version of Record)