Author + information
- Hideaki Kaneda, MD, PhD⁎ ()
- ↵⁎Tokyo Heart Center, 5-4-12 Kita-shinagawa, Shinagawa-ku, Tokyo 141-0001, Japan
I read with interest the paper by Räber et al. (1) comparing patients with multiple drug-eluting stents (DES) in a vessel with overlap with patients with multiple DES in a vessel without overlap and patients with 1 DES/vessel. The authors demonstrated that major adverse cardiac events were more common in patients with DES overlap than in the other groups at 3 years.
First, because the original study demonstrated a significant difference between sirolimus- and paclitaxel-eluting stent groups (2), it would be of great help if the authors would provide data stratified by stent type. Second, overlapping stent implantation was performed for dissection in some cases (28 of 138, 20%). Dissection might be a cause of creatine kinase elevation (myocardial infarction) rather than overlapping stent implantation itself. To clarify this point, it would be of great help if the authors would provide data about peri-procedural creatine kinase elevation and its association with dissection. Third, target lesion revascularization seems to be determined on a per-patient basis. Because there were twice as many lesions/patient (2.0, 394 in 199 patients) in patients with multiple DES in a vessel without overlap compared with the other groups (1.0, 138 in 134 patients; 1.1, 778 in 679 patients), per-patient analysis might overestimate target lesion revascularization rate in patients with multiple DES in a vessel without overlap.
- American College of Cardiology Foundation