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Published on: May 14, 2013
Extended Outcomes of Complex Coronary Disease in the Drug Eluting Stent Era
Kevin P Desrosiers1, Jeremiah R Brown2, Craig A Langner1
1Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Insights
Drug-Eluting Stents (DES) significantly reduce Target Vessel Revascularization (TVR) and Target Lesion Revascularization (TLR) compared to Bare-Metal Stents (BMS). This large regional study found DES use did not compromise patient survival in real-world practice.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Device Technology
Background:
- Randomized trials show Drug-Eluting Stents (DES) reduce Target Vessel Revascularization (TVR) and Target Lesion Revascularization (TLR) versus Bare-Metal Stents (BMS).
- Previous conclusions were based on limited patient and lesion criteria, questioning generalizability to unselected populations.
- The impact of DES on survival, TVR, and TLR in a broad, real-world patient cohort remains under investigation.
Purpose of the Study:
- To evaluate the effect of DES availability on survival, TVR, and TLR in a large regional patient population.
- To assess outcomes in an unselected patient group undergoing percutaneous coronary intervention (PCI) without on-label indication restrictions.
- To compare the efficacy of DES versus BMS in contemporary clinical practice.
Main Methods:
- A retrospective analysis of 6,093 Bare-Metal Stent (BMS) and 5,651 Drug-Eluting Stent (DES) patients from the Northern New England Cardiovascular Disease Study Group PCI registry.
- Patients were stratified into BMS (2001-2002) and DES (2004-2005) eras based on their first PCI procedure.
- One-year outcomes including survival, Target Lesion Revascularization (TLR), and Target Vessel Revascularization (TVR) were measured.
Main Results:
- Survival rates were comparable between the BMS and DES groups after one year.
- Drug-Eluting Stents (DES) demonstrated a significant reduction in Target Lesion Revascularization (TLR) by 4.9% and Target Vessel Revascularization (TVR) by 5.4% compared to Bare-Metal Stents (BMS).
- Propensity matching confirmed these significant differences: Mortality HR 1.00 (95% CI: 0.83-1.28), TLR HR 0.40 (95% CI: 0.32-0.46), TVR HR 0.44 (95% CI: 0.38-0.51).
Conclusions:
- Widespread adoption of Drug-Eluting Stents (DES) in contemporary percutaneous coronary intervention (PCI) practice reduces TVR and TLR risks.
- The benefits of DES in reducing revascularization events are evident in a large, unselected patient population, including off-label use.
- Drug-Eluting Stents (DES) provide these revascularization benefits without adversely affecting patient survival.
Background:
Several randomized trials comparing bare-metal stents to Drug-Eluting Stents (DES) have demonstrated a significant reduction in Target Vessel Revascularization (TVR) and Target Lesion Revascularization (TLR) exists with the use of drug-eluting stents, without compromising survival. These conclusions are based on restricted inclusion criteria for patients and lesion. It is unknown if these results can be generalized to an unselected patient population and more complex disease. The objective of this study was to determine to what extent the availability of DES has impacted survival, TVR, and TLR in a large regional experience without the restriction of on-label indications.
Methods:
Patients registered with the Northern New England Cardiovascular Disease Study Group's PCI registry with single vessel coronary disease undergoing a first PCI were sorted according to the Bare-Metal stent (BMS) era (2001 - 2002) or the Drug-Eluting stent (DES) era (2004 - 2005) based on the time period their first PCI took place. Totally, 6,093 BMS and 5,651 DES patients were identified. Outcomes of survival, TLR and TVR were measured after one year.
Results:
After 1 year, survival was comparable, TLR was reduced by 4.9% (absolute) and TVR was reduced by 5.4% (absolute) in the DES era compared to the BMS era. The TLR/TVR differences remained significant after propensity matching in the DES era vs BMS era (Mortality: HR 1.00, 95% CI: 0.83 - 1.28; TLR: HR 0.40, 95% CI 0.32 - 0.46; TVR: HR 0.44, 95% CI 0.38 - 0.51).
Conclusions:
In large regional experience with a consecutive series of patients representing the contemporary practice of PCI, including both on and off label use, the frequent use of DES reduces the risk of TVR and TLR without compromising survival.
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