Drug-eluting stents did not significantly lower the adjusted risk of death or myocardial infarction compared with bare-metal stents at 1 year (adjusted HR 0.74; 95% CI 0.52-1.07).
Observational (n=6,906)
Yes
Do drug-eluting stents reduce death, myocardial infarction, or target vessel revascularization compared to bare-metal stents in patients undergoing percutaneous coronary intervention?
In a large US registry, drug-eluting stents reduced target vessel revascularization compared to bare-metal stents with similar rates of stent thrombosis at 1 year.
Effect estimate: adjusted HR 0.74 (95% CI 0.52 to 1.07)
Absolute Event Rate: 5.2% vs 9%
p-value: p=0.002
BACKGROUND: The DEScover Registry was designed to characterize patients selected for drug-eluting stents (DES) in routine clinical practice and their outcomes in the United States. METHODS AND RESULTS: From January to June 2005, data were collected on 6906 patients who underwent percutaneous coronary intervention at 140 medical centers. Baseline characteristics and outcomes were compared on the basis of treatment with > or =1 bare-metal (BMS; n=397), sirolimus-eluting (SES; n=3873), or paclitaxel-eluting (PES; n=2636) stent. Clinical characteristics and the types of lesion treated for BMS patients differed substantially from those treated with DES, but minimal differences were noted between DES patients receiving SES or PES. At 1 year, the unadjusted cumulative incidence of death/myocardial infarction was higher in BMS than in DES patients (9.0% versus 5.2%; P=0.002) but similar in SES and PES patients (5.2% versus 5.3%; P=0.64). After adjustment, risk of death/MI was not significantly lower in DES- compared with BMS-treated patients (adjusted hazard ratio, 0.74; 95% confidence interval, 0.52 to 1.07). Although target vessel revascularization occurred less often in DES patients (9.5% versus 6.0%; P=0.007), rates were similar between SES and PES patients (6.3% versus 5.5%; P=0.20). Rates of stent thrombosis were similar among BMS (0.8%), SES (0.5%), and PES (0.8%) patients. CONCLUSIONS: In DEScover, differences in patient selection were observed between BMS and DES patients but not between SES and PES patients. DES use resulted in lower rates of clinically driven repeat revascularization with similar rates of stent thrombosis. These observations confirm the effectiveness and safety of both SES and PES in unselected patients.
Williams et al. (Tue,) conducted a observational in Percutaneous coronary intervention (n=6,906). Drug-eluting stents (DES) vs. Bare-metal stents (BMS) was evaluated on Death or myocardial infarction (adjusted HR 0.74, 95% CI 0.52 to 1.07, p=0.002). Drug-eluting stents did not significantly lower the adjusted risk of death or myocardial infarction compared with bare-metal stents at 1 year (adjusted HR 0.74; 95% CI 0.52-1.07).