impact of direct stenting with "SES"

Iimpact of direct stenting (DS) using the sirolimus-eluting stent (SES) on angiographic and clinical outcomes.
The SES is superior to bare-metal stents in the treatment of native de novo coronary artery lesions in randomized, controlled trials.
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.
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).
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.
* 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
Elsevier Inc.


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