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The main benefit of DES vs. BMS in PCI is reduced revascularization. Recent data also suggest reduced major adverse cardiac events (MACE) with DES used in the context of MI yet many patients (pts), especially the uninsured do not receive DES. We evaluated BMS vs. DES in a public health system (PHS) population with uniform access to healthcare and stratified by presentation acuity.
2,000 pts undergoing PCI at a PHS hospital were analyzed as an open cohort. Pts were included if complete data were available and uniform access to healthcare was provided at the same PHS. Pts were analyzed by DES vs. BMS, stratified by stable vs. unstable (ACS, MI, shock) clinical presentation and followed for MACE (death, MI, urgent TVR).
1,702 pts (57.2 ± 10.2 yrs, 31.8% female, 45.9% AA, 22.5% White) underwent PCI for STEMI (19.2%), NSTEMI (28.0%), unstable angina (24.7%) or stable angina (18.9%). The majority (1,402, 82.4%) received BMS. Clinical follow-up was obtained in 85.1% of pts (n=1702, mean 2.5y ± 1.9 yrs). MACE at 3 years was highest in unstable/BMS pts and lowest in stable/DES pts (Fig. 1). Notably the difference between DES and BMS in the unstable cohort was driven by mortality reduction.
DES confers a MACE and likely mortality advantage over BMS, especially in unstable pts. DES was utilized in the minority of pts in this cohort, likely reflecting a significant selection bias. Additional multivariate analyses are currently underway to evaluate the true magnitude and mechanisms of benefit.
- 2013 American College of Cardiology Foundation