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Time dependency of outcomes for drug-eluting vs bare-metal stents

Alexander A Leung1, Danielle A Southern, P Diane Galbraith

  • 1Department of Medicine, University of Calgary, Alberta, Canada.

The Canadian Journal of Cardiology
|November 26, 2013
PubMed

Insights

First-generation drug-eluting stents showed early benefits in reducing death or repeat procedures. However, these advantages faded over time, with similar long-term outcomes compared to bare-metal stents after eight years.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Biomedical Engineering

Background:

  • First-generation drug-eluting stents (DES) were developed to improve outcomes after percutaneous coronary intervention (PCI).
  • Previous studies suggested an initial benefit of DES over bare-metal stents (BMS).
  • The long-term efficacy and durability of early DES compared to BMS require further investigation.

Purpose of the Study:

  • To evaluate the long-term comparative effectiveness of first-generation DES versus BMS.
  • To assess the time-varying risk of death and repeat revascularization after PCI.
  • To determine if the early benefits of DES persist over an 8-year follow-up period.

Main Methods:

  • Extended analysis of a cohort of 6440 patients undergoing PCI between 2003 and 2005.
  • Comparison of outcomes (death, death or repeat revascularization) between patients receiving DES (sirolimus, paclitaxel) and BMS.
  • Utilized Cox proportional hazards modeling with spline analysis to determine time-dependent, risk-adjusted hazard ratios.

Main Results:

  • Drug-eluting stents demonstrated significantly better outcomes within the first year post-implantation.
  • At 30 days, adjusted hazard ratios for death and death/repeat revascularization were 0.38 and 0.27, respectively.
  • By 8 years, no significant benefit of DES over BMS was observed; adjusted hazard ratios for death and death/repeat revascularization were 1.15 and 1.01, respectively.

Conclusions:

  • First-generation DES provide an early survival and procedural benefit compared to BMS.
  • This early advantage diminishes over time, with no significant difference in long-term outcomes up to 8 years.
  • The findings suggest that the long-term risk profile of early DES is comparable to BMS.
Abstract

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