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European Heart Journal Advance Access originally published online on April 7, 2005
European Heart Journal 2005 26(11):1056-1062; doi:10.1093/eurheartj/ehi191
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

Immediate and mid-term outcomes of sirolimus-eluting stent implantation for chronic total occlusions

Lei Ge1,2, Ioannis Iakovou1, John Cosgrave1, Alaide Chieffo1, Matteo Montorfano1, Iassen Michev1, Flavio Airoldi1, Mauro Carlino1, Gloria Melzi1, Giuseppe M. Sangiorgi1, Nicola Corvaja1 and Antonio Colombo1,*

1EMO Centro Cuore Columbus and San Raffaele Hospital, 48 Via M. Buonarroti, 20145 Milan, Italy
2Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China

Received 31 October 2004; revised 31 January 2005; accepted 3 February 2005; online publish-ahead-of-print 7 April 2005.

* Corresponding author. Tel: +39 02 4812920; fax: +39 02 48193433. E-mail address: info{at}emocolumbus.it

See page 1049 for the editorial comment on this article (doi:10.1093/eurheartj/ehi243)

Aims To evaluate the outcomes of sirolimus-eluting stent (SES) implantation for the treatment of chronic total occlusion (CTO).

Methods and results We identified 122 patients who underwent revascularization in CTO lesions with SES from April 2002 to April 2004 (SES group). A control group was composed of 259 consecutive patients with CTO lesions treated with bare metal stents (BMS) in the 24 months immediately before the introduction of SES (BMS group). At 6-month follow-up, the cumulative rate of major adverse cardiac events (MACE) was 16.4% in the SES group and 35.1% in the BMS group (P<0.001). The incidence of restenosis was 9.2% in the SES group and 33.3% in the BMS group (P<0.001). The need for revascularization in the SES group was significantly lower, both target lesion revascularization (7.4 vs. 26.3%, P<0.001) and target vessel revascularization (9.0 vs. 29.0%, P<0.001). BMS implantation (HR: 2.97; 95% CI: 1.80–4.89; P<0.001), lesion length (>20 mm) (HR: 2.02; 95% CI: 1.37–2.99; P=0.0004), and baseline reference vessel diameter (>2.8 mm) (HR: 0.62; 95% CI: 0.42–0.92; P=0.02) were identified as predictors of MACE during 6-month follow-up.

Conclusion Compared with BMS, SES implantation in CTO lesions appears to be effective in reducing the incidence of restenosis and the need for revascularization at 6 months.

Key Words: Stents • Occlusion • Angioplasty • Revascularization • Restenosis


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