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Time dependent effect on mortality of drug-eluting stents versus bare metal stents

Per Mølstad1

  • 1Feiring Heart Clinic, Norway. moelsta@online.no

Scandinavian Cardiovascular Journal : SCJ
|April 3, 2012
PubMed

Insights

Drug-eluting stents significantly reduced short-term mortality compared to bare metal stents after percutaneous coronary interventions. However, no long-term mortality difference was observed beyond nine months, with potential selection bias noted.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Medical Device Technology

Background:

  • Percutaneous coronary interventions (PCI) are common procedures for treating coronary artery disease.
  • Drug-eluting stents (DES) were developed to reduce restenosis rates compared to bare metal stents (BMS).
  • Long-term mortality differences between DES and BMS remain a subject of investigation.

Purpose of the Study:

  • To compare all-cause long-term mortality between patients treated with DES and BMS.
  • To evaluate the impact of stent type on survival following PCI.

Main Methods:

  • Observational study using data from Feiring Heart Clinic (1999-2010).
  • Survival analysis compared using Cox regression and propensity score matching (1:1).
  • Landmark analysis at 9 months was employed due to nonproportional hazards.

Main Results:

  • Study included 5690 BMS patients and 2916 DES patients; 996 deaths observed.
  • DES showed significantly reduced mortality within the first 9 months (Hazard Ratios 0.42-0.51).
  • No significant difference in mortality was observed between DES and BMS from 9 months to 8 years post-procedure.

Conclusions:

  • Drug-eluting stents significantly reduce short-term mortality compared to bare metal stents.
  • The observed short-term benefit of DES may be influenced by patient selection bias.
  • No long-term mortality advantage of DES over BMS was demonstrated beyond the initial 9-month period.
Abstract

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