This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Applegate, R. J. Articles by Little, W. C. Search for Related Content PubMed Articles by Applegate, R. J. Articles by Little, W. C.

3-Year Comparison of Drug-Eluting Versus Bare-Metal Stents

Wake Forest University School of Medicine, Section of Cardiology, Winston-Salem, North Carolina

^_* Reprint requests and correspondence: Dr. Robert J. Applegate, Section of Cardiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1045 (Email: bapplega{at}wfubmc.edu).

Objectives: The aim of this study was to compare 3-year cumulative outcomes to landmark second- and third-year outcomes with the routine use of drug-eluting stents (DES) (>75% "off-label") with a comparable group treated with bare-metal stents (BMS).

Background: Long-term safety concerns after "off-label" DES use persist, despite recent 2-year data showing comparable safety to BMS use.

Methods: Clinical outcomes (nonfatal myocardial infarction, all-cause mortality) were assessed in 1,147 consecutive patients who received a BMS in the year before the introduction of DES at Wake Forest University Baptist Medical Center and 1,246 consecutive patients that received a DES after it became our routine choice with equivalent complete 3-year follow-up.

Results: Stents were used for "off-label" indications in 80% of DES patients. At 3 years, the hazard ratio for DES compared with BMS for cumulative target vessel revascularization was 0.65 (95% confidence interval [CI]: 0.51 to 0.82), nonfatal myocardial infarction or death was 0.85 (95% CI: 0.71 to 1.03), and all-cause mortality 0.80 (95% CI: 0.64 to 1.01). The DES clinical benefits occurred entirely within the first year, with similar rates of these clinical end points in the second and third year. The cumulative hazard ratio of stent thrombosis DES compared with BMS was 1.07 (95% CI: 0.57 to 2.01), with similar rates of stent thrombosis in the third year (p = 0.70).

Conclusions: The routine clinical use of DES for "off-label" indications was associated with lower clinical end points at 3 years than treatment with BMS in a comparable group of patients, with similar cumulative rates of stent thrombosis. There was no evidence of late "catch-up" of adverse DES events.

Key Words: angioplasty • mortality • stents

Abbreviations and Acronyms   BMS = bare-metal stent(s)   CI = confidence interval   DES = drug-eluting stent(s)   HR = hazard ratio   MI = myocardial infarction   PCI = percutaneous coronary intervention   ST = stent thrombosis   TVR = target vessel revascularization