Three-Year Survival Following Multivessel Percutaneous Coronary Intervention With Bare-Metal or Drug-Eluting Stents in Unselected Patients Neville Kukreja, MA, MRCP, Yoshinobu Onuma, MD, Hector M. Garcia-Garcia, MSc, MD, Joost Daemen, MD, Ron van Domburg, MD, PhD, and Patrick W. Serruys, MD, PhD*, on behalf of the Interventional Cardiologists of the Thoraxcenter (2000-5) Drug-eluting stents (DESs) have been shown to reduce the rate of repeat revascularization compared with bare-metal stents (BMSs) after multivessel percutaneous coronary inter- vention in carefully selected patients. However, the long-term safety and efficacy of DESs in patients with multivessel disease outside the setting of randomized trials was unknown. Therefore, all patients undergoing multivessel percutaneous coronary intervention with BMSs, sirolimus-eluting stents (SESs), or paclitaxel-eluting stents (PESs) from January 2000 to December 2005 were investigated. The primary end point was all-cause mortality. A total of 1,720 patients were recruited in 3 consecutive sequential groups of BMS (n  701; January 2000 to April 2002), SES (n  293; April 2002 to February 2003), and PES (n  726; February 2003 to December 2005). Overall median follow-up was 1,440 days. There was improved 3-year survival in the SES group (93.7%) compared with both the BMS (86.1%) and PES groups (87.3%), which remained significant after propensity score ad- justment for differences in baseline and procedural characteristics (SES vs BMS, adjusted hazard ratio 0.53, 95% confidence interval 0.30 to 0.94; SES vs PES, adjusted hazard ratio 0.49, 95% confidence interval 0.28 to 0.87). There was no difference in mortality between the PES and BMS groups. Both DES types significantly reduced the need for clinically driven target-vessel and target-lesion revascularization without an excess in myocardial infarction or stent thrombosis. In conclusion, both SESs and PESs significantly reduced the need for repeated revascularization in these patients with no excess in mortality. SESs might reduce mortality in patients undergoing multivessel percutaneous coronary intervention. © 2009 Elsevier Inc. (Am J Cardiol 2009;103:203–211) Historically, coronary artery bypass grafting has been the gold standard of treatment for patients with multivessel coronary artery disease. 1 Trials comparing percutaneous coronary intervention using bare-metal stents (BMSs) have shown equivalent mortality, but an increased need for re- peated revascularization compared with coronary artery by- pass grafting. 2–4 The Arterial Revascularization Therapies Study Part II (ARTS-II) found equivalent 3-year survival with drug-eluting stents (DESs) compared with historic cor- onary artery bypass grafting and BMS groups from ARTS-I, although freedom from revascularization was still inferior to coronary artery bypass grafting. 5 Nonetheless, with recent revelations about late and very late stent thrombosis, there were concerns regarding the long-term safety of DESs, particularly in patients treated for “off-label” indications. 6–8 Although there were reports of short-term clinical outcomes after multivessel percutaneous coronary intervention with DESs, 9 –11 longer term comparisons between BMSs and different DESs in unselected patients with multivessel dis- ease were scarce. We therefore analyzed all patients un- dergoing multivessel percutaneous coronary intervention in our institution to ascertain the long-term safety of BMSs, sirolimus-eluting stents (SESs), and paclitaxel- eluting stents (PESs). Methods From January 2000 to December 2005, all patients under- going multivessel percutaneous coronary intervention with a single stent type as their standard treatment were enrolled. We defined multivessel percutaneous coronary intervention as intervention to 2 major epicardial coronary arteries or bypass grafts during the same procedure. Initially, all pa- tients were treated with BMSs, but on April 16, 2002, our institution adopted the use of SESs (Cypher; Cordis, War- ren, New Jersey) as the default strategy for all coronary interventions. On February 16, 2003, SESs were replaced by PESs (Taxus; Boston Scientific, Natick, Massachusetts) as the default stent. This single-center registry therefore consisted of 1,720 patients divided into 3 groups of consec- utive patients of BMS (n = 701; January 2000 to April 2002), SES (n = 293; April 2000 to February 2003), or PES (n = 726; February 2003 to December 2005). The sole exclusion criterion was implantation of 1 different stent Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands. Manuscript received June 10, 2008; revised manuscript received and ac- cepted August 31, 2008. *Corresponding author: Tel: +31-10-463-5260; fax: +31-10-436- 9154. E-mail address: p.w.j.c.serruys@erasmusmc.nl (P.W. Serruys). 0002-9149/09/$ – see front matter © 2009 Elsevier Inc. www.AJConline.org doi:10.1016/j.amjcard.2008.08.068