The sirolimus-eluting coronary stent in clinical practice: impact of direct stenting versus stenting with balloon pre-dilatation.

Abstract

When using bare metal stents (BMS), direct stenting (DS) has become an established method for percutaneous coronary interventions (PCI). If drug-eluting stents are used, DS is currently not recommended. We analysed the data of the German Cypher Stent Registry to evaluate current use and outcome of DS using the sirolimus-eluting stent (SES). 4,437 patients at 122 hospitals who received a single SES for one lesion and completed follow-up, were included. DS was performed in 1,727 (38.9%) of these patients. However, there was a wide range from 0% to 77.8% within the centres. The following factors were independently associated with the use of DS: degree of stenosis (per 10%) (p<0.0001), type C lesion (p<0.0001), three vessel disease (p<0.0001), age (per decade) (p<0.0001), target vessel = LAD (p=0.0029), diabetes mellitus (p=0.0222) and renal insufficiency (p=0.0260). There were no higher event rates for DS compared to predilatation from admission until the end of follow-up: death rates were 1.4% versus 1.9%, p=0.1854, TVR rates 7.9% versus 8.7%, p=0.3388 and TVR or MACCE rates 10.8% versus 12.1%, p=0.2088. This was confirmed after correction for confounding factors. In current clinical practice DS with the SES is performed within a very wide range at the different hospitals. Further predictors for the use of DS with the SES are similar to those known from BMS. DS with the SES in such selected patients seems to be safe and effective.