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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Improved survival with drug-eluting stent implantation in comparison with bare metal stent in patients with severe
Giuseppe Gioia1, William Matthai, Alberto Benassi
1Atlantic City Medical Center, Pomona, New Jersey 08240, USA. giuseppe.gioia@atlanticare.org
Insights
Drug-eluting stents (DES) significantly reduce mortality and major adverse cardiac events (MACE) in patients with severe left ventricular dysfunction compared to bare-metal stents (BMS). This finding highlights DES as a superior treatment option for this high-risk cardiac patient group.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Medicine
Background:
- Patients with severe left ventricular (LV) dysfunction represent a high-risk population for adverse cardiac outcomes.
- Drug-eluting stents (DES) offer a potential advantage over bare-metal stents (BMS) in improving long-term results for these patients.
Purpose of the Study:
- To evaluate the efficacy of drug-eluting stent (DES) implantation versus bare-metal stent (BMS) implantation in patients experiencing ischemic cardiomyopathy with severe left ventricular (LV) dysfunction.
Main Methods:
- A cohort of 191 patients with severe LV dysfunction (LV ejection fraction ≤35%) underwent coronary stent implantation between May 2002 and May 2005.
- 128 patients received DES (Sirolimus or Paclitaxel), while 63 patients received BMS. Patients with acute ST-elevation myocardial infarction (STEMI) were excluded.
- Primary endpoint was cardiovascular mortality; secondary endpoint was a composite of major adverse cardiac events (MACE), including cardiovascular mortality, myocardial infarction (MI), and target vessel revascularization (TVR).
Main Results:
- Mean follow-up was 420 days. Baseline characteristics were similar, except for a higher prevalence of diabetes in the DES group.
- Cardiac death rates were significantly lower in the DES group (6%) compared to the BMS group (24%) (P=0.05).
- The rate of major adverse cardiac events (MACE) was substantially lower for DES (10%) versus BMS (41%) (P=0.003).
Conclusions:
- Drug-eluting stent implantation demonstrates a significant reduction in mortality and MACE in high-risk patients with severe left ventricular dysfunction when compared to bare-metal stents.
- DES implantation is associated with improved outcomes in patients with ischemic cardiomyopathy and severe LV dysfunction.
Objective:
We examined the efficacy of drug-eluting stent (DES) implantation (Sirolimus or Paclitaxel) in patients with ischemic cardiomyopathy and severe left ventricular (LV) dysfunction and compared the outcome with a similar group of patients undergoing bare metal stent (BMS) implantation.
Background:
Patients with severe LV dysfunction are a high risk group. DES may improve the long term outcomes compared with BMS.
Methods:
One hundred and ninety one patients (23% women) with severe LV dysfunction (LV ejection fraction < or =35%) underwent coronary stent implantation between May 2002 and May 2005 and were available for follow-up. One hundred and twenty eight patients received DES (Sirolimus in 72 and Paclitaxel in 54) and 63 patients had BMS. Patients with acute S-T elevation myocardial infarction (STEMI) were excluded. The primary endpoint was cardiovascular mortality. A composite endpoint of major adverse cardiac events (MACE) including cardiovascular mortality, myocardial infarction (MI), and target vessel revascularization (TVR) was the secondary endpoint.
Results:
Mean follow-up was 420 +/- 271 days. No differences were noted in age (69 +/- 10 years vs. 70 +/- 10 years, P = NS), number of vessel disease (2.3 +/- 0.7 vs. 2.2 +/- 0.8, P = NS), history of congestive heart failure (47% vs. 46%, P = NS), MI (60% vs. 61%, P = NS), or number of treated vessels (1.3 +/- 0.5 vs. 1.3 +/- 0.6, P = NS) for the DES and BMS group, respectively. Diabetes was more common among DES patients (45% vs. 25%, P = 0.01). The left ventricular ejection fraction (LVEF) was similar between the two groups (28% +/- 6% vs. 26% +/- 8%, P = NS for the DES and BMS, respectively). During the follow-up, there were a total of 25 deaths of which two were cancer related (2 in DES group). There were 23 cardiac deaths, 8/126 (6%) which occurred in the DES group and 15/63 (24%) in the BMS group (P = 0.05 by log-rank test). MACE rate was 10% for the DES group and 41% for the BMS group (P = 0.003). NYHA class improved in both groups (from 2.5 +/- 0.8 to 1.7 +/- 0.8 in DES and from 2 +/- 0.8 to 1.4 +/- 0.7 in the BMS, P = NS).
Conclusion:
Compared with bare-metal stents, DES implantation reduces mortality and MACE in high risk patients with severe left ventricular dysfunction.