title: Effect of drug-eluting stents on frequency of repeat revascularization in patients with unstable angina pectoris or non-ST-elevation myocardial infarction.
abstract: Drug-eluting stents (DES) have been shown to markedly reduce the need for repeat revascularization compared to bare-metal stents in patients with stable coronary artery disease. The benefit of DES in patients with acute coronary syndromes (ACS) is unclear. This analysis was undertaken to determine if DES have similar advantages over bare-metal stents in patients with ACS. A cohort of 3,771 patients underwent percutaneous coronary intervention with stent implantation in native coronary arteries. Patients presenting for primary angioplasty or rescue angioplasty were excluded. Patients were classified as having stable or unstable symptoms on presentation and then further divided by stent type, DES or bare-metal stent. Although there was a difference in efficacy, with fewer major adverse cardiac events after DES implantation for the stable patients at 1 year (8.2% vs 13.2%, p = 0.008), this benefit was not found in patients with ACS (11.2% vs 12.0%, p = 0.6). A reduced need for repeat revascularization of the initially treated artery accounted for this difference (5.6% vs 11.4%, p <0.001). Stent thrombosis by 1 year was equally rare with each stent type. In conclusion, the reduction in the need for repeat revascularization associated with DES appears to be limited to patients who present with stable angina pectoris. This observation may reflect the more frequent presence of vulnerable plaques in patients with ACS.
authors: Department of Internal Medicine, Washington Hospital Center, Washington, DC, USA.
authors: Yanlin
authors: Y
authors: Li
authors: Rebecca
authors: R
authors: Torguson
authors: Asmir I
authors: AI
authors: Syed
authors: Itsik
authors: I
authors: Ben-Dor
authors: Sara D
authors: SD
authors: Collins
authors: Gabriel
authors: G
authors: Maluenda
authors: Mickey
authors: M
authors: Scheinowitz
authors: Kimberly
authors: K
authors: Kaneshige
authors: Zhenyi
authors: Z
authors: Xue
authors: Gilles
authors: G
authors: Lemesle
authors: Lowell F
authors: LF
authors: Satler
authors: William O
authors: WO
authors: Suddath
authors: Kenneth M
authors: KM
authors: Kent
authors: Joseph
authors: J
authors: Lindsay
authors: Augusto D
authors: AD
authors: Pichard
authors: Ron
authors: R
authors: Waksman
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000601:surgery*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D012086:Reoperation; D016896:Treatment Outcome