Clinical outcomes following percutaneous coronary intervention before and after introduction of drug-eluting stent
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ORIGINAL ARTICLE
Clinical outcomes following percutaneous coronary intervention before and after introduction of drug-eluting stent Ryo Naito1 • Katsumi Miyauchi1 • Manabu Ogita1 • Shuta Tsuboi1 • Hirokazu Konishi1 • Tomotaka Dohi1 • Takatoshi Kasai1 • Hiroshi Tamura1 Shinya Okazaki1 • Kikuo Isoda1 • Hiroyuki Daida1
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Received: 17 January 2015 / Accepted: 6 April 2015 Japanese Association of Cardiovascular Intervention and Therapeutics 2015
Abstract Drug-eluting stents (DES) have demonstrated safety and efficacy in clinical outcomes, especially reduced rate of revascularization. However, it remains unknown whether clinical outcomes related to mortality improved after the introduction of DES. We sought to examine clinical outcomes including all-cause mortality, cardiovascular and non-cardiovascular death in pre-DES and DES eras. This was a single-center retrospective study including patients who underwent percutaneous coronary intervention (PCI) from August 1997 and June 2011. Study population was divided into two groups according to the time period of PCI (August 1997 to July 2004; pre-DES era, August 2004 to June 2011; DES era). The primary endpoint was all-cause mortality and secondary endpoints were cardiovascular and non-cardiovascular mortality. These endpoints were evaluated 3 years after PCI. A total of consecutive 3361 patients from our PCI cohort were analyzed. Patients in DES era were more likely to have traditional risk factors and angiographic disadvantages. The incidence of the primary endpoint was comparable between the two groups (p = 0.053). Cardiovascular and non-cardiovascular mortality were also similar between the groups (p = 0.1 and p = 0.2, respectively). Importantly, non-cardiovascular mortality accounted for over 60 % of all-cause mortality in both eras. DES era was not associated with 3-year all-cause mortality, whereas DES use was associated with a reduction in 3-year cardiovascular mortality (HR 0.16, 95 % CI 0.010–0.9, p = 0.035). All-cause
& Katsumi Miyauchi [email protected] 1
Department of Cardiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan
mortality, cardiovascular and non-cardiovascular mortality at three years were comparable between pre-DES and DES era, despite the higher risk profiles of patients in DES era. Keywords Percutaneous coronary intervention Drugeluting stents Mortality
Introduction Percutaneous coronary intervention (PCI) has evolved with technological advances of devices, improvement in operators’ techniques as well as developing medical therapy for secondary prevention [1–3]. In particular, an introduction of drug-eluting stents (DES) has demonstrated marked reduction in revascularization rate [4–6]. Indeed, indications of PCI have expanded to patients with more comorbidities and more complex coronary artery diseases [7–9]. However, it remains unknown whether outcomes related to mortality improved after the introduction of DES. Thus, we sought to examine and compare clinical outcomes includin
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