Author + information
- Received January 10, 2012
- Revision received May 3, 2012
- Accepted May 23, 2012
- Published online October 1, 2012.
- Manesh R. Patel, MD⁎,⁎ (, )
- Steven P. Marso, MD†,
- David Dai, PhD, MS⁎,
- Kevin J. Anstrom, PhD⁎,
- Kendrick A. Shunk, MD, PhD‡,
- Jeptha P. Curtus, MD§,
- J. Matthew Brennan, MD, MPH⁎,
- Art Sedrakyan, MD, PhD∥,
- John C. Messenger, MD¶ and
- Pamela S. Douglas, MD⁎
- ↵⁎Reprint requests and correspondence
: Dr. Manesh R. Patel, Duke University Medical Center, Duke Clinical Research Institute, 2400 Pratt Street, Durham, North Carolina 27710
Objectives This study sought to investigate the long-term effectiveness of drug-eluting stents (DES) versus bare-metal stents (BMS).
Background Improved recanalization techniques have increased interest in percutaneous coronary intervention (PCI) for chronic total coronary occlusion (CTO). The long-term effectiveness of DES and BMS is not known.
Methods We used data from 10,261 stable patients age ≥65 years at 889 U.S. hospitals who underwent CTO PCI from January 1, 2005, to December 31, 2008, in the NCDR (National Cardiovascular Data Registry) CathPCI Registry with linked Medicare inpatient claims for follow-up. Patient and procedural characteristics, and 30-month death, myocardial infarction, revascularization, and hospitalization for bleeding were evaluated by stent type. Outcomes following stenting were adjusted and compared using propensity score matching.
Results DES were used for CTO PCI in 8,218 (80%) and BMS in 2,043 (20%). DES patients were younger (74.0 vs. 75.5 years, p < 0.001), had longer lesions (18.8 vs. 16.5 mm, p < 0.001), received more stents (≥2 stents in 45.7% vs. 37.9%, p < 0.001), and underwent multivessel PCI (18.9% vs. 15.1%, p < 0.001). DES implantation was associated with a lower hazard of mortality (hazard ratio [HR]: = 0.72, 95% confidence interval [CI]: 0.60 to 0.86, p < 0.001), a similar hazard for myocardial infarction (HR: 0.85, 95% CI: 0.61 to 1.19, p = 0.35), and subsequent revascularization (HR: 0.94, 95% CI: 0.79 to 1.12, p = 0.48), including PCI (HR: 0.98, 95% CI: 0.83 to 1.19, p = 0.87) and coronary artery bypass grafting (HR: 0.71, 95% CI: 0.46 to 1.10, p = 0.12). Hospitalization for bleeding was also similar for DES versus BMS (HR: 0.92; 95% CI: 0.61 to 1.39, p = 0.70).
Conclusions Compared with BMS, DES use in stable patients undergoing CTO PCI was associated with lower mortality, as well as similar myocardial infarction and repeat revascularization rates without an increase in subsequent bleeding requiring hospitalization.
This project was sponsored by the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, Rockville, Maryland, as part of the Cardiovascular Consortium and funded under Project ID 24-EHC-1 and Work Assignment No. HHSAA290-2005-0032—TO4-WA1 as part of the Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) program. The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services. Additional support was obtained from the National Cardiovascular Data Registry, American College of Cardiology, Washington, DC. Dr. Patel has received research grants from NHLB, AHRQ, Johnson and Johnson, AstraZeneca and Maquet and consulted for Bayer, Baxter, Pleuristem, and OrthoMcNeil Jansen. Dr. Marso has a relationship with The Medicines Company, Novo Nordisk, Abbott Vascular, Amylin Pharmaceuticals, Boston Scientific, Volcano Corporation, and Terumo Medical. Dr. Anstrom has received research support from AstraZeneca, Eli Lilly and Company, Medtronic, and Proctor and Gamble; has served as a consultant for Abbot Vascular, AstraZeneca, Bristol-Myers Squibb, and Ikaria; and has served on Data Monitoring Committees for Pfizer and Vertex. Dr. Shunk had received institutional research support from, Abbott Vascular, Siemens Medical Systems, InfraredX and Gilead. Dr. Curtis holds stock in Medtronic and receives salary support from the Analytical Center for American College of Cardiology National Cardiovascular Data Registry. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 10, 2012.
- Revision received May 3, 2012.
- Accepted May 23, 2012.
- American College of Cardiology Foundation