Initial impact of drug-eluting stent use on the spectrum of patients undergoing percutaneous coronary intervention.

Abstract

The availability of drug-eluting stents was expected to expand the application of percutaneous coronary intervention to a wider group of patients and lesion types. We sought to determine whether drug-eluting stents' availability has changed the practices of operators performing percutaneous coronary intervention with regard to patient selection and procedural factors.
We compared the clinical and angiographic characteristics of patients who underwent percutaneous coronary intervention at the Methodist Hospital, Houston, Texas, during three periods: June 2002-March 2003, June 2003-March 2004 and June 2004-March 2005. Sirolimus-eluting stents were available during the latter two periods. Paclitaxel eluting stents became available during the third period.
A greater proportion of patients undergoing diagnostic catheterization were referred for percutaneous coronary intervention during the latter two periods (26.8%, 30.4%, 30.4%, respectively, P<0.0001). Patients undergoing stent placement during the latter two periods were more likely to have hypertension, hyperlipidemia or to have undergone previous percutaneous coronary intervention. The average implanted stent length was greater during the latter periods (14.5+/-4.6, 16.4+/-5.2, 16.8+/-5.5 mm, respectively, P<0.0001) and the average stent diameter was smaller (3.23+/-1.22, 3.13+/-1.16, 3.02+/-0.6 mm, respectively, P<0.0001). The frequency of percutaneous coronary intervention involving long lesions (>20 mm) and Left Anterior Descending (LAD) lesions was higher in the latter two periods and the frequency of multivessel stenting was higher in the last period.
The spectrum of patients and coronary lesions that have undergone stenting has changed, particularly in the third period when both drug-eluting stent types were available. We observed a gradual shift toward higher-risk clinical and lesion characteristics following the introduction of drug-eluting stents.