Bare-metal stents remain important option for some patients
medwireNews: Newer bare-metal and drug-eluting stents offer comparable rates of survival or freedom from myocardial infarction among patients with stable or unstable coronary artery disease, Norwegian researchers report.
There were also no differences between the two device types in the individual endpoints of death, myocardial infarction, stroke or hospitalisation for unstable angina among the 9013 participants of the randomised, multicentre NORSTENT study.
“These observations are important because they balance the claim by some observers that there is no longer a role for bare-metal stents in PCI [percutaneous coronary intervention] because of the superiority of their drug-eluting counterparts in these outcomes”, writes Eric Bates (University of Michigan Medical Center, Ann Arbor, USA) in an editorial for The New England Journal of Medicine, where the findings are published.
At 6 years post-implantation with either a second-generation drug-eluting stent (mainly everolimus or zotarolimus) or a newer-generation bare-metal stent, the composite outcome of death from any cause and nonfatal spontaneous myocardial infarction had occurred in 16.6% and 17.1% of patients, respectively.
This difference was not statistically significant and might be due, in part, to the low rate of thrombosis in both groups say Kaare Bønaa (St Olav’s University Hospital, Trondheim) and co-authors of the study.
Definite stent thrombosis occurred in 0.8% of patients receiving drug-eluting stents and 1.2% of those receiving bare-metal stents, a difference that was statistically significant.
The researchers comment that the long-term safety of drug-eluting stents has been a concern because first-generation drug-eluting stents had higher rates of stent thrombosis than bare-metal stents.
However, “NORSTENT contributes to the growing evidence that contemporary drug-eluting stents, as compared with first-generation drug-eluting stents, may have a lower risk of stent thrombosis than bare-metal stents, and demonstrates that this effect persists during long-term follow-up”, they write.
Furthermore, the rate of any repeat revascularisation was significantly lower in the group receiving drug-eluting stents versus the group receiving bare-metal stents, at 16.5% and 19.8%, respectively.
Based on this finding, Bønaa and team calculated that 30 patients would need to be treated with drug-eluting stents rather than bare-metal stents to prevent one repeat revascularisation.
Bates concludes that findings of this study make second-generation drug-eluting stents the preferred type in most clinical situations.
However, he adds: “The results of this important trial should increase confidence in choosing to implant bare-metal stents in selected patients if clinical indications favor that decision and should support guideline recommendations endorsing that option.”
By Laura Cowen
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