A comparative analysis of major clinical outcomes using drug-eluting stents versus bare-metal stents in a large consecutive patient cohort.
OBJECTIVE
To ascertain the long-term safety, efficacy, and pattern of use of drug-eluting stents (DES) in routine clinical practice.


METHODS
We analyzed a registry of 6,583 consecutive patients undergoing percutaneous coronary intervention (PCI), of whom 2,633 were treated using DES (DES group) and 3,950 were treated using bare-metal stents (BMS group). Propensity score was used for stratified analysis of outcomes and for matching. Outcomes were total mortality, myocardial infarction (MI), repeat target vessel revascularization (TVR) rates, and risk-adjusted event-free survival.


RESULTS
Follow-up time was 6 months to 5.18 years (mean: 3 years). Patients in the DES group were more likely to be diabetic and had use of longer or more stents, treatment of more lesions and of more proximal main vessels. After propensity score matching, the cumulative mortality was 12.85% in the DES group versus 14.14% in the BMS group (P = 0.001). Use of DES reduced the occurrence of MI (5.17% vs.5.83%, P = 0.046), of clinically driven TVR (9.76% vs. 12.28%, P < 0.001) and of the composite endpoint of death/MI/TVR (23.38% vs. 26.07%; P < 0.001).


CONCLUSIONS
Our risk-adjusted event-free survival analysis indicates a prognostic benefit for DES utilization that sustains up to 5 years following PCI.
Bental
Tamir
T
Cardiology Department, Rabin Medical Center, Tel-Aviv University, Israel. tamir_b@zahav.net.il
Assali
Abid
A
Vaknin-Assa
Hana
H
Lev
Eli I
EI
Brosh
David
D
Fuchs
Shmuel
S
Battler
Alexander
A
Kornowski
Ran
R
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D015331:Cohort Studies; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007557:Israel; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D010818:Practice Patterns, Physicians'; D057216:Propensity Score; D011474:Prosthesis Design; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome
D008670:Metals