impact of direct stenting with "SES"

Objectives
Iimpact of direct stenting (DS) using the sirolimus-eluting stent (SES) on angiographic and clinical outcomes.
Background
The SES is superior to bare-metal stents in the treatment of native de novo coronary artery lesions in randomized, controlled trials.
Methods
A post hoc analysis was performed on 225 patients (158 men; 62 ± 11 years old) who received SES in the pooled cohorts of the European and Canadian Sirolimus-Eluting Stent in Coronary Lesions (E-SIRIUS and C-SIRIUS, respectively) trials. Of these patients, 57 (25%) had undergone DS at the investigator's discretion. Lesion predilation preceded SES implantation in the remaining 168 patients.
Results
Patient and lesion characteristics were no different between the two subgroups, except for a lower prevalence of moderate to severe lesion calcification (5% vs. predilation 19%, p = 0.017) and a lower baseline diameter stenosis (61.6% vs. predilation 68.1%, p < 0.001) in the DS subgroup. At eight months, in-lesion late loss (0.10 vs. 0.19 mm at predilation, p = 0.14) and in-lesion binary restenosis (2.0% vs. 6.1% at predilation, p = 0.46) tended to be lower after DS. Clinical follow-up at one year revealed non-significantly reduced incidences of target lesion revascularization (1.8% vs. 5.4% at predilation, p = 0.46) and major adverse cardiac events (5.3% vs. 8.9% at predilation, p = 0.57).
Conclusions
Direct SES deployment performed at the investigator's discretion was as safe and efficacious at mid-term follow-up as stenting preceded by lesion predilation.
Abbreviations and acronyms: CI, confidence interval; C-SIRIUS, Canadian Sirolimus-Eluting Stent in Coronary Lesions trial; DS, direct stenting; E-SIRIUS, European Sirolimus-Eluting Stent in Coronary Lesions trial; MACE, major adverse cardiac events; MI, myocardial infarction; MLD, minimum lumen diameter; SES, sirolimus-eluting stent(s); SIRIUS, Sirolimus-Eluting Stent in Coronary Lesions trial; TLR, target lesion revascularization
Article footnote
This study was sponsored by Cordis, a Johnson & Johnson Company.
Affiliations
* Center for Cardiology and Vascular Intervention, Hamburg, Germany
† Glenfield Hospital, Leicester, United Kingdom
‡ Hôpital du Sacré-Coeur de Montréal, Montréal, Canada
§ Onze Lieve Vrouw Ziekenhuis, Aalst, Belgium
∥ Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany
Reprint requests and correspondence:
*Reprint requests and correspondence: Dr. Joachim Schofer, Othmarscher Kirchenweg 168, D-22763 Hamburg, Germany
Source
Elsevier Inc.

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