NEW YORK (Reuters Health) – In patients with chronic total coronary occlusions, drug-eluting stents (DES) have better long-term outcomes than bare metal stents, according to a paper from Italy.

When non-simultaneous cohorts treated with the two types of stents were compared, DES reduced the 3-year risk of major adverse cardiac events — death, myocardial infarction, and target vessel revascularization — and therefore “should be considered the preferred treatment strategy,” the authors said.

In the December issue of the Journal of the American College of Cardiology: Cardiovascular Interventions, the research team notes that long-term results of DES for chronic total coronary artery occlusions have been conflicting. Whereas one study showed an increased rate of target vessel revascularization with sirolimus-eluting stents, another found that such stents provide better outcomes than bare metal stents.

In the current study, Dr. Francesco De Felice and colleagues, from UO Cardiologia Interventistica Ospedaliera S. Camillo Forlanini in Rome, compared 124 patients treated with DES between 2003 and 2006 with 159 who received bare metal stents in an earlier era.

At 3 years after stent placement, the major adverse cardiac event rate in the DES group was significantly lower than in the bare metal stent group: 18% vs. 28% (p < 0.05). This finding was driven by a lower rate of target vessel revascularization with DES: 8% vs. 21% (p < 0.004).

Independent predictors of fewer events included use of a DES, shorter lesion length, greater final minimal lumen diameter, and lower residual stenosis percent, the authors conclude.

Dr. De Felice and co-authors acknowledge that theirs was not a randomized trial. Despite this and other limitations of their study, they maintain, their findings are from “a real-world cohort of patients that had never been analyzed before.”

In a related editorial, Dr. James E. Tcheng and Dr. David A. Zidar, from Duke University Medical Center, Durham, North Carolina, comment that a “large, parallel-group, prospective study is still needed” to confirm the optimal stent type for total coronary occlusion. “In the meantime, the welcome contributions of De Felice et al add to the growing body of evidence arguing for the use of DES in this off-label population.”

Reference:
J Am Coll Cardiol Intv 2009;2:1260-1265.