Prognostic impact of using drug-eluting-stents on outcome and strategy in multivessel PCI: data from the Frankfurt MV-PCI registry.

Background: Drug-eluting-stents (DES) reduce clinical restenosis, but have mostly failed to demonstrate a reduction in death or myocardial infarction. The aim of this study was to evaluate the prognostic impact of the introduction of DES in patients undergoing multivessel percutaneous coronary intervention (MV-PCI).

Methods: Survival was assessed in 679 consecutive patients, who underwent PCI in at least two main vessels. Follow-up was available in 667 patients (98%) with a mean follow-up of 4.8 ± 2.5 years. We compared several scenarios: firstly, patients receiving at least one DES (≥ 1 DES group) vs. bare metal stent (BMS)-only patients (BMS only); secondly, the population was divided into a pre-DES-era (2000-2003; N=257) and a DES-era (2004-2006; N=422).

Results: 316 patients (47%) were treated for acute myocardial infarction (MI; N=176 ST-elevation MI; N=140 non-ST-elevation MI). On average, 2.2 ± 0.4 vessels were treated and 212 patients received at least one DES. The DES group showed a higher number of diseased (2.5 ± 0.6 vs. 2.4 ± 0.5; p=0.02) and treated vessels (2.2 ± 0.5 vs. 2.1 ± 0.3; p<0.01) and received more stents (3.3 ± 1.4 vs. 3.0 ± 1.1; p<0.01). The BMS group presented more frequently with acute MI (55% vs. 29%; p<0.01). The DES group showed more complex disease as evidenced by a higher SYNTAX-Score (17.4 ± 8.5 vs. 14.5 ± 8.3; p<0.01). Restricting the survival analysis to patients with stable coronary artery disease, a significant prognostic advantage was found for patients received at least one DES compared to the BMS group (hazard ratio 0.58, 95% confidence interval 0.34-0.99) in the multivariate cox-regression-analysis.

Conclusion: The introduction of DES leads to extension of treatment to more complex patients. The use of DES is associated with improved survival in stable patients undergoing MV-PCI.