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Long-term safety and efficacy of drug-eluting versus bare-metal stents in Sweden
Stefan K James1, Ulf Stenestrand, Johan Lindbäck
1Department of Cardiology, Uppsala University Hospital, Uppsala, Sweden. stefan.james@akademiska.se
The New England Journal of Medicine
|May 8, 2009
Summary
Drug-eluting stents show similar long-term safety to bare-metal stents regarding death or heart attack. However, they significantly reduce restenosis rates, especially in high-risk patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomaterials Science
Background:
- Long-term safety and efficacy of drug-eluting coronary stents (DES) have been debated.
- Concerns exist regarding potential adverse events associated with DES compared to bare-metal stents (BMS).
Purpose of the Study:
- To compare the long-term safety and efficacy of DES versus BMS in a large patient cohort.
- To evaluate the incidence of death, myocardial infarction, and restenosis between DES and BMS implantation.
Main Methods:
- A retrospective analysis of 47,967 patients undergoing coronary stent implantation in Sweden (2003-2006).
- Comparison of outcomes between patients receiving a single DES (10,294) and a single BMS (18,659).
- Statistical adjustment for patient, vessel, and lesion characteristics was performed.
Main Results:
- No significant difference in the combined endpoint of death or myocardial infarction between DES and BMS groups (RR 0.96; 95% CI, 0.89 to 1.03).
- Drug-eluting stents demonstrated a significantly lower rate of restenosis (3.0 vs 4.7 events per 100 patient-years).
- Among high-risk patients, DES reduced restenosis by 74% (NNT=10 lesions).
Conclusions:
- Drug-eluting stents are associated with comparable long-term rates of death or myocardial infarction compared to bare-metal stents.
- Drug-eluting stents provide a clinically significant reduction in restenosis, particularly beneficial for high-risk patient populations.
