CCI: DES benefits validated out to five years
Drug-eluting stents (DES) sustain a prognostic benefit up to five years following PCI, based on a survival analysis published in the September issue of Catheterization and Cardiovascular Interventions.
Tamir Bental, MD, and colleagues from the cardiology department at the Rabin Medical Center (Beilinson Hospital and Golda-Hasharon Hospital) in Petach-Tikva, Israel, sought to ascertain the long-term safety, efficacy and pattern of DES use in routine clinical practice.
The researchers analyzed a registry of 6,583 consecutive patients undergoing PCI between April 1, 2004, and Dec. 31, 2008, of whom 2,633 were treated using DES and 3,950 were treated using bare-metal stents (BMS). They used a propensity score for stratified analysis of outcomes and for matching. Outcomes were total mortality, MI, repeat target vessel revascularization (TVR) rates and risk-adjusted event-free survival.
All patients were prescribed lifelong aspirin and clopidogrel for at least three months after BMS implantation and three to 12 months following DES implantation, the authors wrote. Also, the mean follow-up period was three years, with a range of six months to 5.18 years.
Of the patients with DES, the researchers reported that 66 percent had a DES only, whereas 34 percent had a combination of a DES and a BMS. Sirolimus-eluting stents (Cypher, Cordis) were used in 57.5 percent of these patients, paclitaxel-eluting stents (Taxus, Boston Scientific) in 12.4 percent, zotarolimus-eluting stents (Endeavor, Medtronic) in 17.3 percent, everolimus-eluting stents (Xience V, Abbott) in 8.4 percent, other DES brands in 1 percent and a combination of various DES in 3.5 percent.
Patients in the DES group were more likely to be diabetic and utilize longer or more stents, treatment of more lesions and of more proximal main vessels. After propensity score matching, they found that the cumulative mortality was 12.85 percent in the DES group versus 14.14 percent in the BMS group, which the authors deemed “significantly lower.”
Specifically, 56 percent of deaths occurred during the index or a subsequent hospitalization, according to the authors. In a sub-analysis of probable causes of death that were abstracted from hospital diagnoses, the largest group was cardiac death, significantly more in the BMS group (49.3 vs. 34 percent). The second largest group was infectious causes, almost equal in both groups (27.8 vs. 29.9 percent).
The authors also reported that use of DES reduced the occurrence of MI (5.17 vs. 5.83 percent), of clinically driven TVR (9.76 vs. 12.28 percent) and of the composite endpoint of death, MI and TVR (23.38 vs. 26.07 percent).
While Bental and colleagues acknowledged that the survival benefit was “not necessarily a surprise,” they wrote that the reduced restenosis over the long-term study period indicates a “marked prognostic benefit.” Also, the researchers attributed the benefits with the pattern of DES use in their particular practice; specifically, “treatment of more territories and more sites per territory, probably leading to a more complete revascularization.”
Tamir Bental, MD, and colleagues from the cardiology department at the Rabin Medical Center (Beilinson Hospital and Golda-Hasharon Hospital) in Petach-Tikva, Israel, sought to ascertain the long-term safety, efficacy and pattern of DES use in routine clinical practice.
The researchers analyzed a registry of 6,583 consecutive patients undergoing PCI between April 1, 2004, and Dec. 31, 2008, of whom 2,633 were treated using DES and 3,950 were treated using bare-metal stents (BMS). They used a propensity score for stratified analysis of outcomes and for matching. Outcomes were total mortality, MI, repeat target vessel revascularization (TVR) rates and risk-adjusted event-free survival.
All patients were prescribed lifelong aspirin and clopidogrel for at least three months after BMS implantation and three to 12 months following DES implantation, the authors wrote. Also, the mean follow-up period was three years, with a range of six months to 5.18 years.
Of the patients with DES, the researchers reported that 66 percent had a DES only, whereas 34 percent had a combination of a DES and a BMS. Sirolimus-eluting stents (Cypher, Cordis) were used in 57.5 percent of these patients, paclitaxel-eluting stents (Taxus, Boston Scientific) in 12.4 percent, zotarolimus-eluting stents (Endeavor, Medtronic) in 17.3 percent, everolimus-eluting stents (Xience V, Abbott) in 8.4 percent, other DES brands in 1 percent and a combination of various DES in 3.5 percent.
Patients in the DES group were more likely to be diabetic and utilize longer or more stents, treatment of more lesions and of more proximal main vessels. After propensity score matching, they found that the cumulative mortality was 12.85 percent in the DES group versus 14.14 percent in the BMS group, which the authors deemed “significantly lower.”
Specifically, 56 percent of deaths occurred during the index or a subsequent hospitalization, according to the authors. In a sub-analysis of probable causes of death that were abstracted from hospital diagnoses, the largest group was cardiac death, significantly more in the BMS group (49.3 vs. 34 percent). The second largest group was infectious causes, almost equal in both groups (27.8 vs. 29.9 percent).
The authors also reported that use of DES reduced the occurrence of MI (5.17 vs. 5.83 percent), of clinically driven TVR (9.76 vs. 12.28 percent) and of the composite endpoint of death, MI and TVR (23.38 vs. 26.07 percent).
While Bental and colleagues acknowledged that the survival benefit was “not necessarily a surprise,” they wrote that the reduced restenosis over the long-term study period indicates a “marked prognostic benefit.” Also, the researchers attributed the benefits with the pattern of DES use in their particular practice; specifically, “treatment of more territories and more sites per territory, probably leading to a more complete revascularization.”