title: Comparison of Baseline Characteristics and Inhospital Outcomes of Patients and Use of Bare Metal Versus Drug-Eluting Stents During Percutaneous Coronary Intervention 2005 to 2015 at a Single Tertiary Hospital.
abstract: With steady growth in the use of drug-eluting stents (DES), the indications for bare metal stents (BMS) have significantly changed over the last decade. This study aims to describe trends in the use of BMS and the evolution of the population receiving them over the past 10 years and determine patient characteristics associated with using BMS. Consecutive patients who underwent percutaneous coronary intervention (PCI) at the Washington Hospital Center from January 2005 through March 2015 were included. Baseline characteristics and inhospital outcomes of patients who underwent PCI with BMS versus DES were compared during 2 different time periods: from 2005 to 2010 and from 2011 to 2015. Multivariable analyses were performed for each period of time to determine independent variables associated with the choice of BMS rather than DES; 20,321 patients who underwent PCI were included in the present study. The mean age was 65.0 ± 12.5 years, 65.2% were men, and 30.4% were black. BMS use peaked in 2007 (47%) but has fallen steadily since; BMS accounted for only 10% of stents used in 2015. Presentation with acute coronary syndrome or cardiogenic shock was more common in patients receiving a BMS; this was reflected in higher rates of inhospital mortality and major bleeding among patients receiving BMS versus DES. Covariables independently associated with receiving a BMS common to both time periods included black race, Hispanic ethnicity, cardiogenic shock or acute coronary syndrome, oral anticoagulation, current smoking, increasing age, lower hematocrit, and history of chronic renal insufficiency. In conclusion, there has been a precipitous decline in the use of BMS over the last decade. Newer stent technology that promises shorter duration of dual antiplatelet therapy is likely to lead to the extinction of BMS over the next decade.
authors.affiliation: Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Romain
authors.initials: R
authors.lastname: Didier
authors.affiliation: Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gaglia
authors.affiliation: Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lipinski
authors.affiliation: Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Edward
authors.initials: E
authors.lastname: Koifman
authors.affiliation: Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Sarkis
authors.initials: S
authors.lastname: Kiramijyan
authors.affiliation: Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Smita
authors.initials: S
authors.lastname: Negi
authors.affiliation: Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Jiaxiang
authors.initials: J
authors.lastname: Gai
authors.affiliation: Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.affiliation: Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.affiliation: Division of Cardiology, MedStar Washington Hospital Center, Washington, DC. Electronic address: ron.waksman@medstar.net.
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D054058:Acute Coronary Syndrome / Q000601:surgery*; D058186:Acute Kidney Injury / Q000453:epidemiology; D000368:Aged; D001803:Blood Transfusion; D054855:Drug-Eluting Stents; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008670:Metals; D008875:Middle Aged; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D011474:Prosthesis Design; D012770:Shock, Cardiogenic / Q000601:surgery; D015607:Stents; D020521:Stroke / Q000453:epidemiology; D062606:Tertiary Care Centers; D016896:Treatment Outcome
chemical_list: D008670:Metals