Are drug-eluting stents indicated in large coronary arteries? Insights from a multi-centre percutaneous coronary intervention registry Bryan P. Yan a , Andrew E. Ajani a,g,h , Gishel New b , Stephen J. Duffy c , Omar Farouque d,h , James Shaw c , Martin Sebastian e , Robert Lew f , Angela Brennan g , Nick Andrianopoulos g , Chris Reid g , David J. Clark d,h, ⁎ on behalf of Melbourne Interventional Group Investigators a Department of Cardiology of the Royal Melbourne Hospital, Australia b Department of Cardiology of the Box Hill Hospital, Australia c Department of Cardiology of the Alfred Hospital, Australia d Department of Cardiology of the Austin Hospital, Australia e Department of Cardiology of the Geelong Hospital, Australia f Department of Cardiology of the Frankston Hospital, Australia g NHMRC Centre of Clinical Research Excellence in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia h University of Melbourne, Australia Received 29 October 2007; received in revised form 11 June 2008; accepted 28 June 2008 Available online 15 August 2008 Abstract Background: Restenosis rates are low in large coronary vessels ≥ 3.5 mm after bare-metal stent (BMS) implantation. The benefit of drug- eluting stents (DES) in large vessels is not established. Objective: We aim to assess clinical outcomes after deployment of BMS compared to DES in patients with large coronary vessels ≥ 3.5 mm. Methods: We analysed 672 consecutive patients undergoing percutaneous coronary interventions with ≥ 3.5 mm stent implantation in native coronary artery de-novo lesions from the Melbourne Interventional Group (MIG) registry. Baseline characteristics, 30-day and 12-month outcomes of patients receiving BMS were compared to DES. Multivariate analysis was performed to identify predictors of major adverse cardiac events [MACE, consisting of death, myocardial infarction (MI) and target vessel revascularisation (TVR)]. Results: Of the 672 PCIs performed in 844 lesions, DES was implanted in 39.5% (n = 333) and BMS in 60.5% (n = 511) of lesions. Patients who received DES compared to BMS were older, more likely to be diabetic, had left ventricular dysfunction b 45% or complex lesions. Significantly fewer patients who presented with ST-elevation MI received DES compared to BMS. There were no significant differences in 12-month mortality (0.5 vs. 2.9%, p = 0.07), TVR (3.6 vs. 4.8%, p = 0.54), MI (6.3 vs. 3.4%, p = 0.15), stent thrombosis (0.9 vs. 1.0%, p = 0.88), or MACE (9.4 vs. 9.4%, p = 0.90) in patients who received DES vs. BMS. Stent length ≥ 20 mm was the only independent predictor of 12-month MACE (Odds Ratio 2.07, 95% CI 1.14–3.76, p = 0.02). Conclusion: In this registry, BMS implantation in large native coronary vessels ≥ 3.5 mm was associated with a low risk of MACE and repeat revascularization at 12 months that was comparable to DES. © 2008 Elsevier Ireland Ltd. All rights reserved. Keywords: Percutaneous coronary intervention; Drug-eluting stents; Bare-metal stents 1. Introduction Vessel size is an important determinant of restenosis in patients undergoing percutaneous coronary intervention International Journal of Cardiology 130 (2008) 374 – 379 www.elsevier.com/locate/ijcard ⁎ Corresponding author. Department of Cardiology, Level 5, Austin Hospital, 145 Studley Road, Heidelberg, Victoria 3084, Australia. Tel.: +61 3 9496 5527; fax: +61 3 9459 0971. E-mail address: clarkdavidj@hotmail.com (D.J. Clark). 0167-5273/$ - see front matter © 2008 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2008.06.046