In-stent restenosis in a real world STEMI registry: Bare Metal versus Drug Eluting Stents

Hiemstra, B. (2013) In-stent restenosis in a real world STEMI registry: Bare Metal versus Drug Eluting Stents. thesis, Medicine.

Text HiemstraB.pdf Restricted to Registered users only Download (1MB)

Abstract

Background: Primary Percutaneous Coronary Intervention (PCI) has made huge leaps of improvement in the last two decades, with the ever goal being permanent sufficient flow in the coronary artery. From balloon angioplasty alone to subsequent Bare Metal Stent (BMS) implantation, measures have been made to achieve this aim. The introduction of the Drug Eluting Stent (DES) proved an ever better outcome: the antiproliferative drug coated struts seemed to cause an end to the last barrier of coronary reclosure: neo-intimal hyperproliferation inside the stent. However, contradicting results with regard to stent safety and effectiveness have been published and therefore we sought to compare the BMS with the DES in a real world STEMI-registry. Primarily, we aimed to investigate the DES ability in preventing target lesion revascularizations (TLR) as a result of in-stent restenosis. Our secondary endpoint was to compare both safety and effectiveness of both stent types. Methods: Follow-up of all indications for recatheterizations at the University Medical Centre Groningen (UMCG) was gathered to achieve our endpoint data. A real world comparable STEMI-cohort, with 2989 stent receiving patients regardless of lesion complexity and type, was analyzed. We also compared the outcomes in different generation stents in de novo lesions. Additionally, we matched our population for known in-stent restenosis predictors to imitate a randomized control trial (RCT) setting. Finally, we sought to identify predictors of our endpoints using both logistic and Cox regression models. Results: In our real world analysis, the DES was associated with less TLR (1,6% compared to 4,9% for BMS) and showed a positive trend in safety and effectiveness. Further generation specific analysis showed the new DES stent is more effective in reducing TLR (P = 0,016 for new DES versus 0,050 for old DES). Our matched populations displayed similar results and moreover showed the new DES stent was safer than the new BMS (10,3% versus 16,9%), but not more effective. Predictors identified for in-stent restenosis were use of DES, stent diameter and stent length. Conclusion: In a real world comparable registry, the DES proved to be a superior device: the incidence of in-stent restenosis is significantly lower. A more detailed analysis shows that the incidence of in-stent restenosis is even lower in the newer DES. Furthermore, the DES stent was defined as safer, but not more effective in a median follow-up op 760 days. The predictors found for both endpoints are concomitant with literature.

Item Type:	Thesis (Thesis)
Supervisor name:	Harst, P. van der and Wieringa, W.G.
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:48
Last Modified:	25 Jun 2020 10:48
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/926

Actions (login required)

View Item