Authors

• Zvonimir Ostojić — Medicinski fakultet Sveučilišta u Zagrebu, Klinički bolnički centar Zagreb, Zagreb, Hrvatska — ORCID: 0000-0003-1762-9270
• Marijan Pašalić — Medicinski fakultet Sveučilišta u Zagrebu, Klinički bolnički centar Zagreb, Zagreb, Hrvatska — ORCID: 0000-0002-3197-2190
• Joško Bulum — Medicinski fakultet Sveučilišta u Zagrebu, Klinički bolnički centar Zagreb, Zagreb, Hrvatska — ORCID: 0000-0002-1482-6503

Abstract

**Introduction:** Drug eluting stents (DES) proved to be superior to bare metal stents (BMS) with regard to target lesion failure (TLF). (1, 2) However, there are limited studies comparing contemporary DES and BMS that take into count technique of stenting. **Methods:** 1201 consecutive patients with percutaneous coronary interventions (PCI) of left anterior descending (LAD) coronary artery, performed from January 2012 to December 2016, were included. Patients were stratified according to PCI with contemporary DES or BMS (cobalt chrome with thin struts). All procedures were reviewed to determine frequency of direct stenting and non-direct stenting (n-DS) - composed of lesion pre-dilatation and/or stent optimization. Cumulative incidence of clinical TLF (composed of in-stent restenosis (ISR) and stent thrombosis (ST)) was assessed. **Results:** Mean patients age was 64.2 years, with majority being men (74.9%, N=896). BMS was implanted in 61.3% (N=741) of cases. DES implantation was more often performed during elective PCI in patients with known coronary artery disease (36.7 vs. 19.3%) with more often achieved final TIMI 3 flow (94.7 vs. 85.7%). N-DS was performed more often in DES group (78 vs. 55.5%), just as all of its components; lesion pre-dilatation (68.7 vs. 48.6%) and stent optimization (45 vs. 36.7%). Increase in n-DS has been observed during studied years. Patient median follow-up was 2.6 years. TLF was significantly more common in BMS group (9.3 vs. 4.3%, p<0.001). However, this was mainly driven due to significant deference in ISR (7.8 vs. 3.0%, p<0.001). There was no significant differences in ST and its subcategories between groups. Results were unaffected by stenting technique. **Conclusion**: Although, stenting technique does not directly influence TLF, using contemporary stents and implantation technique significant reduction of TLF is achievable compared to historic data. Furthermore, presented real world results suggest incidence of ISR and ST similar to the one observed in modern randomized control trials.

Keywords

percutaneous coronary intervention, stent, in-stent restenosis, stent thrombosis

DOI

Literature

1. Valgimigli M, Tebaldi M, Borghesi M, Vranckx P, Campo G, Tumscitz C, et al. Two-year outcomes after first- or second-generation drug-eluting or bare-metal stent implantation in all-comer patients undergoing percutaneous coronary intervention. JACC Cardiovasc Interv. 2014 Jan;7(1):20–8. https://doi.org/10.1016/j.jcin.2013.09.008
2. Bønaa KH, Mannsverk J, Wiseth R, Aaberge L, Myreng Y, Nygård O, et al. Drug-Eluting or Bare-Metal Stents for Coronary Artery Disease. N Engl J Med. 2016 Sep 29;375(13):1242–52. https://doi.org/10.1056/NEJMoa1607991