Direct stenting compared to balloon predilation in drug-eluting stents†

Objectives: We sought to examine the determinants and outcomes of direct stenting (DS) compared to predilation with drug-eluting stents (DES). Background: Limited data suggest that DS with DES is feasible and may reduce restenosis compared to predilation. Whether DS improves clinical outcomes in unselected patients treated with DES is unknown. Methods: DEScover is a prospective, multicenter, observational study of percutaneous coronary intervention that enrolled patients in 2005. The analysis cohort included 4,210 patients who received a DES and had a single lesion treated with DS (n = 1,651) or predilation (n = 2,559) at the discretion of the operator. Multivariable analysis was performed for 1-year outcomes. Results: DS was performed in 39.2% of patients. The direct stent patients were younger, less often male, and had a lesser extent of CAD. DS was performed less often in patients presenting with an acute myocardial infarction (MI) and more often in stable angina and elective procedures. Lesion characteristics differed with DS performed less often for calcified lesions, high-grade stenoses (>90%), and bifurcation lesions. Lesion postdilation was less common in direct stent patients (42.1% vs. 50.7%, P = 0.0001). Complete procedural success was similar (99.8% vs. predilation 99.7%, P = 0.46). At 1 year, there was no difference in the adjusted hazard ratios of death (0.67, 0.44–1.04, P = 0.08), MI (1.05, 0.66–1.67, P = 0.83), stent thrombosis (0.38, 0.13–1.14, P = 0.08), TLR (0.75, 0.48–1.17, P = 0.21), TVR (0.89, 0.64–1.23, P = 0.47), and major adverse coronary event (0.88, 0.71–1.09, P = 0.24). Conclusions: DS with DES is commonly performed in clinical practice and results in similar long-term outcomes as predilation. © 2011 Wiley Periodicals, Inc