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Clinical outcomes after multilesion percutaneous coronary intervention: comparison between exclusive and selective
Olivier F Bertrand1, Benjamin Faurie, Eric Larose
1Department of Cardiology, Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie, affilié à l'Université Laval, 2725, Chemin Ste Foy, Québec, Canada, G1V 4G5. olivier.bertrand@crhl.ulaval.ca
Insights
A selective drug-eluting stent (DES) strategy for high-restenosis risk lesions was safe and effective, showing similar outcomes to exclusive DES use in patients with multiple coronary lesions.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomedical Engineering
Background:
- Percutaneous coronary interventions (PCI) often involve multiple lesions.
- Drug-eluting stents (DES) reduce restenosis but increase cost and bleeding risk.
- Optimizing DES use is crucial for patient outcomes and healthcare economics.
Purpose of the Study:
- To compare outcomes of a selective DES strategy versus an exclusive DES strategy in patients undergoing multi-lesion PCI.
- To evaluate acute and late clinical events, including major adverse cardiac events and stent thrombosis.
Main Methods:
- A comparative study of 362 patients with 900 multi-lesion PCIs.
- Selective DES group used DES for lesions meeting 4 high-restenosis risk criteria; exclusive DES group used DES for all lesions.
- Outcomes assessed at a mean follow-up of 412 days, with propensity score adjustment for multivariate analysis.
Main Results:
- Major adverse cardiac events (16.8% vs. 18.4%, p=0.78) and revascularization rates (9.9% vs. 10.5%, p=1.0) were similar between exclusive and selective DES groups.
- Multivariate analysis showed no significant difference in revascularization or target lesion revascularization (TLR) between strategies.
- Stent thrombosis was significantly lower in the selective DES group (0.5%) compared to the exclusive DES group (3.7%, p=0.03).
Conclusions:
- A selective DES strategy, using DES only for high-risk lesions, is safe and effective compared to exclusive DES use in multi-lesion PCI.
- The selective approach may reduce stent thrombosis rates.
- Further prospective randomized trials are needed to confirm these findings and validate the criteria-based selective DES strategy.
Objectives:
This study compared acute and late outcomes following a strategy of selective drug-eluting stent (DES) use guided by a set of 4 criteria defining higher risk of in-stent restenosis compared to an exclusive DES strategy in 362 patients with multilesion (n = 900) percutaneous coronary interventions.
Results:
At a mean follow up of 412 +/- 110 days, major adverse cardiac events (death, myocardial infarction, revascularization) were 16.8% in the exclusive DES group compared to 18.4% in the selective DES group (p = 0.78). By univariate analysis, revascularization rates (9.9% in the exclusive DES group versus 10.5% in the selective DES group; p = 1.0) and target lesion revascularization (TLR) rates (5.5% versus 6.2%; p = 0.77) were similar in the 2 groups. By multivariate analysis adjusted by propensity score to account for differences in baseline characteristics, the strategy of exclusive DES use was not associated with lower risks of revascularization (hazard ratio [HR]: 0.91, 95% confidence interval [CI] 0.64-1.29) or TLR (HR: 0.81, 95% CI 0.59-1.08) compared with selective DES use. Using the Academic Research Consortium criteria, stent thrombosis occurred in 6/161 (3.7%) cases in the exclusive DES group and in 1/201 (0.5%) case in the selective DES group (p = 0.03).
Conclusions:
In patients with multiple coronary lesions, a selective DES strategy for lesions at higher risk of restenosis and bare-metal stents for other lesions was safe and effective when compared to the exclusive use of DES. A large, prospective, randomized trial is required to validate a criteria-based selective DES strategy compared to systematic DES use.
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