Simultaneous drug-eluting and bare-metal stent implantation: long-term clinical outcome and findings of clinically indicated coronary angiography.

ABSTRACT

BACKGROUND: Simultaneous drug-eluting stent (DES) and bare-metal stent (BMS) implantation is occasionally employed in clinical practice, but its long-term clinical and angiographic outcome is not clear. HYPOTHESIS: We aimed to describe the long-term clinical outcome and the findings of clinically indicated coronary angiography in patients subjected to simultaneous DES and BMS implantation ("hybrid stenting"). METHODS: We identified 236 patients (mean age 62.9 ± 11.4 years, 76.7% men) who had undergone percutaneous coronary intervention with at least 1 DES and 1 BMS. At a median follow-up of 42 months (range, 6-89 months) available in 222 patients, 13 (5.9%) patients died from cardiac causes, 13 (5.9%) experienced nonfatal acute myocardial infarction, and 24 (10.8%) experienced unstable angina. Clinically indicated repeat coronary angiography was performed in 64 patients (28.8%). RESULTS: Thirty-one patients (14%) had target lesion revascularization (TLR). The DES demonstrated lower TLR rates (15.9% vs 36.9%, P = 0.002) and lower late loss (0.44 ± 0.5 mm vs 0.68 ± 0.7 mm, P = 0.009) compared with BMS. Use of DES was independently associated with lower risk for binary restenosis (hazard ratio [HR] 0.41, 95% confidence interval [CI] 0.19-0.89, P = 0.03) and TLR (HR 0.26, 95% CI 0.12-0.54, P<0.001). CONCLUSIONS: Although a hybrid stenting strategy demonstrates a reasonable long-term prognosis even in high-risk patients, DES have a better angiographic outcome compared with BMS under the influence of common patient-related restenosis risk factors.