DES associated with reduced target vessel revascularization
MedWire News: Drug-eluting stents (DES) are associated with a significant reduction in target-vessel revascularization compared with bare-metal stents (BMS), research shows.
Although there were no overall significant differences in cumulative mortality, reinfarction, or stent thrombosis, landmark analysis revealed that the incidence of very late reinfarction and stent thrombosis was significantly increased with DES, report Giuseppe De Luca (Eastern Piedmont University, Novara, Italy) and colleagues.
They conducted a meta-analysis of data from 11 trials that included 6298 patients who underwent percutaneous coronary intervention for ST-segment-elevation myocardial infarction (STEMI). The findings are reported in the Archives of Internal Medicine.
Of these, 3980 (63.2%) were randomly allocated to receive DES implantation and 2318 (36.8%) to BMS implantation.
At long-term follow-up (mean 1201 days), DES implantation significantly reduced the occurrence of target-vessel revascularization compared with BMS (12.7 vs 20.1%, p<0.001), without any significant difference in terms of mortality, reinfarction, or stent thrombosis.
Moreover, patients who underwent DES implantation were at a 43% lower risk for target-vessel revascularization than those who underwent BMS implantation.
However, additional analysis using a Cox model with time-varying regression coefficients showed that the hazard ratio for reinfarction and stent thrombosis changed over time. This suggested that at long-term follow-up, reinfarction and stent thrombosis rates increased significantly in the DES group compared with the BMS group, at hazard ratios of 2.06 and 2.81, respectively (p<0.04 for both).
"Despite these worrisome findings, the authors conclude that this study provides reassurance that the DES benefits in STEMI warrant the potential risks," editorialist James Brophy (McGill University, Montreal, Canada) remarks.
He says that clinicians "should be concerned about the lack of precision with the current results."
Brophy recommends that an "informed" patient with STEMI must be told that substituting DES for BMS in 100 patients is not likely to result in mortality differences, but does lead to approximately five fewer repeat revascularizations at the cost of one additional late reinfarction, with the possibility that the true risk may be substantially higher.
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By Piriya Mahendra