Introduction 

The impact on clinical outcomes of the metal coverage on the coronary surface (namely the metal-to-artery ratio) of currently used drug-eluting stents (DESs) has not been defined.

Methods 

All patients with a left main or bifurcation stenosis treated with percutaneous coronary intervention (PCI) using ultrathin stents (struts thinner than 81 μm) were enrolled with a prospective multicentre fashion. The rate of device-oriented endpoint [DOE, defined as a composite of target lesion revascularization (TLR) and stent thrombosis] was the primary endpoint, while its single components were the secondary ones, evaluated according to the metal-to-artery ratio.

Results 

After 14 ± 10.4 months 62 (7.5%) of 830 patients undergoing PCI on left main experienced a DOE without differences in the metal-to-artery ratio (14.5 ± 2.1 vs. 14.4 ± 1.9, P = 0.51). Fifty out (2.4%) of 2082 patients treated with PCI on a coronary bifurcation other than left main experienced a DOE, with a higher mean metal-to-artery ratio (15.3 ± 2.1 vs. 14.6 ± 2, P = 0.01). At multivariate analysis, together with hypertension and diabetes, the metal-to-artery ratio was an independent predictor of DOE (hazard ratio 1.7 : 1.02–1.34, P = 0.02) in nonleft main PCI. When analysed for diameter, we found a significant correlation with DOE when the stent diameter was inferior to 3.0 mm (hazard ratio 1.21: 1.06–1.38, P < 0.01, all 95% confidence interval); this result was mainly consistent for patients treated with provisional stenting. The metal-to-artery ratio does not impact on outcomes in left main PCI, both in the provisional or two-stent technique, and generally when a drug-eluting stent more than 3.5 mm in diameter is implanted. Regarding nonleft main PCI, it is independently related to DOE and TLR, especially for DES with a diameter of 3.25 mm or less.

Conclusion 

The metal-to-artery ratio does not impact on outcomes in left main PCI, both in the provisional or two-stent technique, and generally when a drug-eluting stent more than 3.5 mm in diameter is implanted. Regarding nonleft main PCI, it is independently related to DOE and TLR, especially for DES with a diameter of 3.25 mm or less.

中文翻译：

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金属与动脉比率对左主干和非左主干分叉的临床结局的影响：RAIN-CARDIOGROUP VII研究的见解（在现实生活中，为左mAIn或分叉的患者使用薄型支架）。

介绍 

目前尚未定义目前使用的药物洗脱支架（DES）在冠状表面金属覆盖（即金属与动脉的比率）对临床结局的影响。

方法 

使用超薄支架（厚度小于81μm的支架）经皮冠状动脉介入治疗（PCI）治疗的左主干或分叉狭窄的所有患者。装置导向终点的比率[DOE，定义为靶病变血运重建（TLR）和支架血栓形成的复合物]是主要终点，而其单个零件是次要零件，根据金属与动脉比率进行评估。

结果 

在14±10.4个月后，左主干接受PCI的830名患者中有62名（7.5％）经历了DOE，金属与动脉比率没有差异（14.5±2.1对14.4±1.9，P = 0.51）。五十出（2.4％）与PCI上的经处理的2082名患者冠状动脉分叉比其他左主经历了DOE，具有较高的平均金属-动脉比（15.3±2.1对14.6±2，P = 0.01）。在多变量分析中，连同高血压和糖尿病，金属与动脉比率是DOE的独立预测因子（危险比1.7：1.02-1.34，P= 0.02）在非左主PCI中。当进行直径分析时，当支架直径小于3.0 mm时，我们发现与DOE显着相关（危险比1.21：1.06-1.38，P <0.01，所有95％置信区间）；该结果主要与临时支架置入患者一致。所述金属-动脉比确实对结果在不影响左主PCI时，无论是在临时或两个支架技术，一般的药物洗脱支架超过3.5毫米直径的植入。对于非左主PCI，它独立于DOE和TLR，特别是对于直径为3.25 mm或更小的DES。

结论 

所述金属-动脉比确实对结果在不影响左主PCI时，无论是在临时或两个支架技术，一般的药物洗脱支架超过3.5毫米直径的植入。对于非左主PCI，它独立于DOE和TLR，特别是对于直径为3.25 mm或更小的DES。