title: Off-label use of drug-eluting versus bare metal stents: a lesion-specific systematic review of long-term outcomes.
abstract: OBJECTIVE
  The purpose of this systematic review was to evaluate differences in lesion-specific outcomes with the "off-label" use of drug-eluting stents (DES) versus bare metal stents (BMS).
  
  
  METHODS
  MEDLINE, PubMed, the Cochrane databases, and other Web were searched for studies evaluating off-label use of DES and BMS with the same characteristics. Of 1,258 abstracts or manuscripts reviewed, 112 studies were included (total N = 23,438). Studies were excluded if patients received both types of stent or no stent; lesion type was unknown; lesion-specific outcomes for ≥6 months were unavailable; or <25 patients were enrolled.
  
  
  RESULTS
  Overall mortality at 6-12 months was approximately 3% for BMS and DES for off-label use. Increase in mortality was greater from 6-12 months to 2 years with BMS than with DES (3.3%-9.1%; 2.8%-4.1%); however, rates were similar at 3 years (BMS: 18.8%; DES:15.3%). Myocardial Infarction rates were similar for both types at 6-12 months (BMS: 6.5%; DES: 6.0%). Overall rates of stent thrombosis were 1.8% and 1.7% for BMS and DES, respectively. Similar or slightly lower rates of stent thrombosis were seen for most lesion types, except higher rates for small vessels for BMS (5.2%) and true bifurcation for DES (3.3%). Rates of target lesion revascularization (TLR) were 7.5% for BMS and 19.6% for DES at 6-12 months. At 2-years TLR remained lower than DES. When the combined group was compared to registry data alone, similar values were seen.
  
  
  CONCLUSIONS
  Rates of mortality, myocardial infarction (MI), and stent thrombosis were similar in patients receiving BMS or DES, while TLR rates were lower in DES patients.
authors.affiliation: Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA. n-beohar@northwestern.edu
authors.forename: Nirat
authors.initials: N
authors.lastname: Beohar
authors.forename: Sheridan N
authors.initials: SN
authors.lastname: Meyers
authors.forename: Ata
authors.initials: A
authors.lastname: Erdogan
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Harinstein
authors.forename: Karen
authors.initials: K
authors.lastname: Pieper
authors.forename: Stephanie
authors.initials: S
authors.lastname: Gagnon
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Davidson
mesh_terms: D000368:Aged; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000601:surgery*; D056687:Off-Label Use; D012044:Regression Analysis; D015607:Stents / Q000009:adverse effects; D013927:Thrombosis / Q000401:mortality* / Q000601:surgery*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods