Key result
In propensity-matched patients undergoing percutaneous coronary intervention, drug-eluting stents were associated with a lower 5-year risk of major adverse clinical events compared to bare-metal stents (46% vs 54%, HR 0.80).
Why the study?
DES showed better clinical outcomes than BMS mostly with different DAPT durations, and clinical superiority of DES over BMS may depend on medication adherence to DAPT.
Does medication adherence to dual antiplatelet therapy affect the long-term clinical superiority of drug-eluting stents over bare-metal stents in patients undergoing percutaneous coronary intervention?
Cohort (n=47,291)
Yes
Does medication adherence to dual antiplatelet therapy affect the long-term clinical superiority of drug-eluting stents over bare-metal stents in patients undergoing percutaneous coronary intervention?
Hazard Ratio: 0.8 (95% CI 0.7–0.91)
Absolute Event Rate: 46% vs 54%
p-value: p=<0.001
Good adherence to dual antiplatelet therapy in the first 6 months is essential for achieving the clinical benefits of drug-eluting stents over bare-metal stents.
Poor DAPT adherence may negate DES benefits vs BMS; hypothesis-generating for adherence interventions, should not yet change practice.
BACKGROUND: In percutaneous coronary intervention, drug-eluting stent (DES) showed better clinical outcome compared to bare-metal stent (BMS) but mostly with different DAPT durations. HYPOTHESIS: The clinical superiority of DES over BMS may depend on the medication adherence to dual antiplatelet therapy (DAPT). METHODS: We retrospectively enrolled all Koreans PCI patients in year 2011 (n = 47,291). Medication adherence to DAPT was assessed by proportion of days covered (PDC) per 6 months. Analysis adjusted with the clinical propensity for receiving DES or BMS and DAPT PDC of the first 6 month was performed. Primary outcome was the 5-year major adverse clinical event (MACE) risk consisting all-cause death, revascularization, shock, or stroke. RESULTS: Patients with DES (n = 46,356) showed higher PDC (78% versus 60%, p<0.001) and lower MACE risk (39% versus 56%, p<0.001) compared to patients with BMS (n = 935). In the propensity-matched 1,868 patients, MACE risk was lower with DES than BMS (46% versus 54%, HR = 0.80, 95% CI = 0.70-0.91, p<0.001). In both DES and BMS, patients with good medication adherence (PDC ≥80%) showed much lower MACE risk compared to patients with PDC <80% (HR = 0.36, 95% CI = 0.30-0.44; HR = 0.40, 95%CI = 0.33-0.48, p<0.001, all). Patients with DES and PDC <80% showed higher MACE risk compared to BMS with and PDC ≥80% (HR = 1.30, 95%CI = 1.03-1.64, p = 0.027). CONCLUSIONS: Good medication adherence to DAPT in the first 6 month was prerequisite for better clinical outcome in both DES and BMS. DES with poor adherence to DAPT showed worse outcome compared with BMS with good adherence.
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Choi et al. (2020) conducted a cohort in Percutaneous coronary intervention (n=47,291). Drug-eluting stent (DES) vs. Bare-metal stent (BMS) was evaluated on 5-year major adverse clinical event (MACE) risk consisting of all-cause death, revascularization, shock, or stroke (HR 0.80, 95% CI 0.70-0.91, p=<0.001). In propensity-matched patients undergoing percutaneous coronary intervention, drug-eluting stents were associated with a lower 5-year risk of major adverse clinical events compared to bare-metal stents (46% vs 54%, HR 0.80).
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