Insights from the DESIRE registry, the longest (11 years) single center follow-up of a real world population treated exclusively with drug-eluting stents

Abstract

Aims: Despite the extensive knowledge accrued on DES in the past years, there is still lack of consistent data on the very late outcomes of these devices, especially after 5 years of their implantation. We sought to provide the longest clinical follow-up data on outcomes of unselected patients treated solely with DES Methods and results: The DESIRE registry is a prospective, single-center registry encompassing all consecutive patients treated solely with DES since May 2002. The primary goal is the very long-term occurrence of MACE and stent thrombosis (ST). Patients were clinically followed at 1, 6 and 12 months and then annually. A multivariate model was built to determine independent predictors of MACE, TLR and ST. A total of 4,500 patients were included. The mean age was 64±11 years. DM was detected in 29.7% and 44.8% presented with acute coronary syndrome. SVG lesions and STEMI represented 6% and 12% of the cohort, respectively. Follow-up was obtained in 98.5% of the patients (median 5.6 years). Currently, 79.6% of the population is free of any MACE. TVR was performed in 5.3% of the patients. Q-wave MI rate was only 1.7% while total ST rate was 1.9%. The majority of definite ST cases occurred between the 1st and 3rd years. Independent predictors of MACE were treatment of SVG (HR 1,63; 95% CI, 1.22 to 2.18, p= 0.001), multivessel disease (HR 1.39; 95% CI, 1.03 to 1.87, p<0.001), residual stenosis (HR 1.3; 95% CI, 1.1 to 1.5, p= 0.034), DM (HR 1.6; 95% CI, 1.1 to 2.2, p= 0.006) and renal insufficiency (HR 1.5; 95% CI, 1.34 to 1.81, p= 0.004). Independent predictors of ST were PCI for STEMI (HR 3.5; 95% CI, 1.3 to 9.4, p= 0.013), stent length (HR 1.8; 95% CI, 1.09 to 3.02, p=0.023), moderate/severe calcification at lesion site (HR 2.38; 95% CI, 1.34 to 4.23, p=0.003), and in-stent residual stenosis (HR 1.04; 95% CI, 1.01 to 1.06, p=0.003). Patient oriented and device oriented updated MACE update to 10 years will be available at the time of the meeting. Conclusion: The DESIRE registry probably represents the longest FU of a real world cohort treated solely with DES. In our single center experience, the use of DES was associated with very long-term safety and effectiveness with acceptable low rates of adverse clinical events, including ST. Also, there was no steady annual increment in the occurrence of ST, with a marked decrease of this complication after the 3rd year of FU.