The clinical outcome of restricting drug-eluting stents to patients at highest risk of restenosis.
OBJECTIVE
To assess the clinical outcomes of patients where drug eluting stents (DES) were restricted to those at highest risks of restenosis, we compared three different strategies for stent implantation: bare metal stents (BMS) only, DES only and a group where DES use was restricted (RES).


RESULTS
Initial comparison was made between BMS only (279 patients, 316 lesions) and DES only (272 patients, 302 lesions). The endpoints of death, non-fatal myocardial infarction and target lesion revascularisation (TLR) [MACE] were assessed at 12 months. The incidence of MACE in the BMS only and DES only groups were 14% and 7% (p=0.002) and TLR was 8% and 1% (p<0.0001). Comparison was then made between these results and a third group where DES was restricted to patients at highest risk of restenosis. The restricted group (RES) comprised 249 patients (271 lesions) of which 53% received DES. RES remained significantly better than BMS, MACE (14% vs. 8%, p=0.02) and TLR (8% vs. 3%, p=0.02). When RES was compared with DES only, there was no significant difference in MACE (8% vs. 7% p=0.42), but there was a significantly lower TLR rate in the DES only group (1% vs. 3% p=0.04).


CONCLUSIONS
The overall incidence of events in patients where DES use was restricted to 53% of patients remains low and this may be an acceptable treatment strategy to reduce costs.
Roy
Probal
P
Department of Cardiology, Royal Melbourne Hospital, Victoria, Australia.
Yan
Bryan P
BP
Bowyer
Andrea
A
Ajani
Andrew E
AE
Lefkovits
Jeffery
J
Warren
Roderic J
RJ