ALERT: This system is being upgraded on Tuesday December 12. It will not be available
for use for several hours that day while the upgrade is in progress. Deposits to DukeSpace
will be disabled on Monday December 11, so no new items are to be added to the repository
while the upgrade is in progress. Everything should be back to normal by the end of
day, December 12.
Downstream coronary effects of drug-eluting stents.
Abstract
BACKGROUND: Antiproliferative agents used in drug-eluting stents (DES) attenuate atherosclerosis,
yet DES implantation has been linked to endothelial dysfunction. The downstream effects
of DES on new lesion formation have not been previously directly examined. We sought
to compare the development of de novo stenoses and need for treatment in the downstream
coronary vessel of patients treated with DES or a bare-metal stent. METHODS: Angiographic
images and procedural information were prospectively collected on 463 adults who underwent
implantation of a single stent in a proximal coronary artery, had an appropriate control
vessel for comparison, and subsequently returned for intervention. Propensity matching
identified 89 pairs of patients. End points were defined as angiographic identification
of a de novo stenosis or need for secondary intervention in the downstream vessel
within 12 months of initial intervention. RESULTS: In the overall (P < .01) and propensity-matched
cohort (P = .01), there was reduced risk of new lesions downstream to DES. No difference
was seen in respective control vessels (P = .14 and P = .99). A reduced need for downstream
intervention with DES was seen in both the overall (P = .01) and propensity-matched
cohorts (P = .04). No difference was seen in the control vessels (P = .98 and P =
.36). Multivariate proportional hazards modeling of known atherosclerosis risk factors
identified stent type as the sole predictor for downstream lesions (P < .01) and downstream
events (P = .02). CONCLUSIONS: Patients receiving DES appear less likely to develop
downstream stenoses and events compared with patients receiving bare-metal stents,
suggesting beneficial downstream drug delivery.
Type
Journal articleSubject
AgedCoronary Restenosis
Coronary Stenosis
Drug-Eluting Stents
Female
Humans
Male
Middle Aged
Prospective Studies
Permalink
https://hdl.handle.net/10161/11022Published Version (Please cite this version)
10.1016/j.ahj.2011.08.001Publication Info
Krasuski, Richard A; Cater, George M; Devendra, Ganesh P; Wolski, Kathy; Shishehbor,
Mehdi H; Nissen, Steven E; ... Ellis, Stephen G (2011). Downstream coronary effects of drug-eluting stents. Am Heart J, 162(4). pp. 764-771.e1. 10.1016/j.ahj.2011.08.001. Retrieved from https://hdl.handle.net/10161/11022.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
Collections
More Info
Show full item recordScholars@Duke
Richard Andrew Krasuski
Professor of Medicine
Dr. Richard Krasuski is Director of the Adult Congenital Heart Center at Duke University
Medical Center, the Director of Hemodynamic Research, and the Medical Director of
the CTEPH Program. He is considered a thought leader in the fields of pulmonary hypertension
and congenital heart disease. His research focus is in epidemiologic and clinical
studies involving patients with pulmonary hypertension and patients with congenital
heart disease. He is involved in multiple multicenter studies thr

Articles written by Duke faculty are made available through the campus open access policy. For more information see: Duke Open Access Policy
Rights for Collection: Scholarly Articles
Works are deposited here by their authors, and represent their research and opinions, not that of Duke University. Some materials and descriptions may include offensive content. More info