European Heart Journal Advance Access originally published online on February 8, 2007
European Heart Journal 2007 28(13):1583-1591; doi:10.1093/eurheartj/ehl423
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Clinical impact of in-stent late loss after drug-eluting coronary stent implantation
1 Department of Interventional Cardiology, University Hospital La Paz, Paseo La Castellana, 261, 28046 Madrid, Spain
2 Hospital Clinico San Carlos, Madrid, Spain
Received 8 April 2006; revised 22 October 2006; accepted 10 November 2006; online publish-ahead-of-print 8 February 2007.
* Corresponding author. Tel: +34 917277545. E-mail address: raulmorenog{at}terra.es
Aims: Controversy exists about the clinical significance of in-stent late loss (ISLL) after drug-eluting stent (DES) implantation. We sought to clarify whether ISLL after DES implantation is related to a potential clinical impact.
Methods and results: We included in a meta-regression analysis 21 trials (8641 patients) that randomly compared DES with bare-metal stents (BMS). We evaluated the relationship between angiographic behaviour of DES and the clinical impact of using DES instead of BMS in each trial using meta-regression techniques, weighting by the number of patients included in each trial. Mean ISLL in patients allocated to DES and 
ISLL (difference in ISLL in patients allocated to BMS and DES) were used as angiographic parameters of efficacy of DES. The number of patients needed to be treated (NNT) to prevent one target lesion revascularization (TLR) was used to quantify the clinical impact of using DES instead of BMS. There was a significant relationship between mean ISLL in patients allocated to DES and the clinical benefit of using DES instead of BMS, as measured with the NNT for TLR: NNT for TLR = 6.2 + 18.4 [ISLL-DES] (R = 0.62; P = 0.007). Therefore, a 0.1 mm increase in mean ISLL-DES was associated with a 1.8 increase in NNT for TLR. There was also a significant association between the degree of inhibition of neointimal hyperplasia of DES in comparison with BMS with the NNT for TLR: NNT for TLR = 17.1–11.8 [ISLL] (R = 0.61; P = 0.008). Therefore, a 0.1 mm reduction in ISLL by using DES instead of BMS was associated with a 1.2 decrease in mean NNT for TLR.
Conclusion: There is a strong and significant association between the degree of inhibition of neointimal formation with the use of DES and the clinical impact of using DES instead of BMS.
Key Words: Number of patients needed to treat • Drug-eluting stents • Restenosis
Presented in part at the Scientific Sessions of the American Heart Association, Dallas, TX, USA, November 2005.
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