Synergy Between Direct Coronary Stenting Technique and Use of the Novel Thin Strut Cobalt Chromium Skylor™ Stent: the Mace in Follow Up Patients Treated with Skylor Stent [MILES Study]

摘要

BACKGROUND: Despite significant improvements in stent platform, currently available bare-metal stentsn(BMS) are still associated with restenosis. Thin-strut design cobalt-chromium alloys hold the promise of improving resultsnof BMS, especially when implanted with direct technique. We performed an observational study to appraise outcomes ofnthe novel Skylor™ stent, stratifying outcomes according to stenting technique.nMETHODS and RESULTS: We included all consecutive patients undergoing coronary stenting with Skylor™ at 2 centersnbetween 2006 and 2009. The primary end-point was the long-term rate of major adverse cardiac events (MACE, i.e.ndeath, myocardial infarction (MI), coronary artery bypass grafting (CABG) or target vessel revascularization (TVR)). Asnpre-specified analysis, we compared patients undergoing direct stenting versus those stent implantation following predilation.nA total of 1020 patients were included (1292 Skylor™ stents), with procedural success obtained in 99%. Comparingnpatients undergoing direct stenting (66%) versus pre-dilation (34%) at 16±7 months of follow-up, MACE had occurrednin, respectively, 8% versus 14% (p=0.001), with death in 1% versus 2% (p=0.380), MI in 1% versus 2% (p=0.032),nCABG in 0.2% versus 2% (p=0.012), and TVR in 6% versus 9% [p=0.071]. Even at multivariable analysis with propensitynadjustment, direct stenting was associated with significantly fewer MACE [hazard ratio 0.60 [0.38-0.93], p=0.024].nCONCLUSIONS: This observational study suggests the presence of a beneficial synergy between direct coronary stentingntechnique and use of the novel thin-strut cobalt-chromium Skylor™ stent in real-world patients undergoing PCI.