| Title | Outcomes following coronary stenting in the era of bare-metal vs the era of drug-eluting stents. | | Author(s) | Malenka DJ, Kaplan AV, Lucas FL, Sharp SM, Skinner JS | | Institution | Section of Cardiology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA. david.malenka@hitchcock.org | | Source | JAMA 2008 Jun 25; 299(24):2868-76. | | MeSH | Aged
Angioplasty, Transluminal, Percutaneous Coronary
Cohort Studies
Coronary Artery Bypass
Coronary Restenosis
Coronary Stenosis
Drug-Eluting Stents
Female
Humans
Male
Medicare
Myocardial Infarction
Myocardial Revascularization
Proportional Hazards Models
Risk
Stents
Survival Analysis
Thrombosis
Treatment Outcome
United States
| | Abstract | CONTEXT: Although drug-eluting stents reduce restenosis rates relative to bare-metal stents, concerns have been raised that drug-eluting stents may also be associated with an increased risk of stent thrombosis. Our study focused on the effect of stent type on population-based interventional outcomes.
OBJECTIVE: To compare outcomes of Medicare beneficiaries who underwent nonemergent coronary stenting before and after the availability of drug-eluting stents.
DESIGN, SETTING, AND PATIENTS: Observational study of 38,917 Medicare patients who underwent nonemergent coronary stenting from October 2002 through March 2003 when only bare-metal stents were available (bare-metal stent era cohort) and 28,086 similar patients who underwent coronary stenting from September through December 2003, when 61.5% of patients received a drug-eluting stent and 38.5% received a bare-metal stent (drug-eluting stent era cohort). Follow-up data were available through December 31, 2005.
MAIN OUTCOME MEASURES: Coronary revascularization (percutaneous coronary intervention, coronary artery bypass surgery), ST-elevation myocardial infarction, survival through 2 years of follow-up.
RESULTS: Relative to the bare-metal stent era, patients treated in the drug-eluting stent era had lower 2-year risks for repeat percutaneous coronary interventions (17.1% vs 20.0%, P < .001) and coronary artery bypass surgery (2.7% vs 4.2%, P < .01). The difference in need for repeat revascularization procedures between these 2 eras remained significant after risk adjustment (hazard ratio, 0.82; 95% confidence interval, 0.79-0.85). There was no difference in unadjusted mortality risks at 2 years (8.4% vs 8.4%, P =.98 ), but a small decrease in ST-elevation myocardial infarction existed (2.4% vs 2.0%, P < .001). The adjusted hazard of death or ST-elevation myocardial infarction at 2 years was similar (hazard ratio, 0.96; 95% confidence interval, 0.92-1.01).
CONCLUSION: The widespread adoption of drug-eluting stents into routine practice was associated with a decline in the need for repeat revascularization procedures and had similar 2-year risks for death or ST-elevation myocardial infarction to bare-metal stents. | | Language | eng | | Pub Type(s) | Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
| | PubMed ID | 18577731 |
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