Comparison of long‐term outcomes of bare‐metal and paclitaxel‐eluting stents in New York

AIMS: Bare-metal stents (BMS) as the first-generation coronary stent and paclitaxel-eluting stents (PES) as a first-generation drug-eluting stent have been employed in percutaneous coronary intervention (PCI). However, the long-term comparative effectiveness of BMS versus PES in real practice remains unclear. To assess long-term outcomes for patients undergoing PCI with either BMS or PES placement and to determine comparative effectiveness of BMS versus PES in six 'off-label' and two 'high-risk' patient subgroups. METHODS AND RESULTS: A longitudinal database was created by linking the New York State cardiac registries, statewide hospital discharge data, the National Death Index and the US Census file (2010) for patients undergoing PCI with BMS or PES placement in 2006 and 2007. Outcomes included all-cause mortality, acute myocardial infarction (AMI), target vessel PCI (TVPCI) and target vessel coronary artery bypass graft (TVCABG) surgery for a 5.5-year follow-up period. A total of 13 879 propensity score matched pairs were compared with respect to outcomes using Kaplan-Meier method with further adjustment using Cox proportional hazards regression. At 5.5 years, PES use was associated with significantly lower mortality (adjusted hazard ratio (AHR): 0.73, 95% confidence interval < CI>: 0.69-0.77), AMI (AHR: 0.90, 95% CI: 0.83-0.98), TVPCI (AHR: 0.92, 95% CI: 0.86-0.99) and TVCABG (AHR, 0.63, 95% CI: 0.53-0.74). For 'off-label' and 'high-risk' subgroups, PES was associated with lower mortality and improved/similar AMI, TVPCI and TVCABG rates relative to BMS. CONCLUSIONS: Compared with BMS, PES was associated with improved mortality and better or comparable AMI, TVPCI and TVCABG outcomes at 5.5 years.