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Previous Volume 357:1393-1402 October 4, 2007 Number 14 Next

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ABSTRACT

Background The placement of drug-eluting stents decreases the frequency of repeat revascularization procedures in patients undergoing percutaneous coronary intervention (PCI) in randomized clinical trials. However, there is uncertainty about the effectiveness of drug-eluting stents, and increasing concern about their safety, in routine clinical practice.

Methods From the Cardiac Care Network of Ontario's population-based clinical registry of all patients undergoing PCI in Ontario, Canada, we identified a well-balanced cohort of 3751 pairs of patients, matched on the basis of propensity score, who received either bare-metal stents alone or drug-eluting stents alone during an index PCI procedure between December 1, 2003, and March 31, 2005. The primary outcomes of the study were the rates of target-vessel revascularization, myocardial infarction, and death.

Results The 2-year rate of target-vessel revascularization was significantly lower among patients who received drug-eluting stents than among those who received bare-metal stents (7.4% vs. 10.7%, P<0.001). Drug-eluting stents were associated with significant reductions in the rate of target-vessel revascularization among patients with two or three risk factors for restenosis (i.e., presence of diabetes, small vessels [<3 mm in diameter], and long lesions [20 mm]) but not among lower-risk patients. The 3-year mortality rate was significantly higher in the bare-metal–stent group than in the drug-eluting–stent group (7.8% vs. 5.5%, P<0.001), whereas the 2-year rate of myocardial infarction was similar in the two groups (5.2% and 5.7%, respectively; P=0.95).

Conclusions Drug-eluting stents are effective in reducing the need for target-vessel revascularization in patients at highest risk for restenosis, without a significantly increased rate of death or myocardial infarction.

Source Information

From the Institute for Clinical Evaluative Sciences (J.V.T., M.C., D.T.K., P.C.A., Y.H.) and Sunnybrook Health Sciences Centre, University of Toronto (J.V.T., D.T.K., E.A.C.) — both in Toronto; McMaster University, St. Joseph's Healthcare, Hamilton, Ont. (J.B., R.H., J.-E.T., G.B., R.G.); and Trillium Health Sciences Centre, Mississauga, Ont. (C.L.) — all in Canada.

Address reprint requests to Dr. Tu at the Institute for Clinical Evaluative Sciences, G106-2075 Bayview Ave., Toronto, ON M4N 3M5, Canada, or at tu{at}ices.on.ca.

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• Genereux, P. MD, Mehran, R. MD (2009). Are drug-eluting stents safe in the long term?. CMAJ 180: 154-155 [Full Text]  
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• Alfonso, F. (2008). The "vulnerable" stent why so dreadful?. J Am Coll Cardiol 51: 2403-2406 [Full Text]  
• Dixon, S. R., Grines, C. L., O'Neill, W. W. (2008). The year in interventional cardiology.. J Am Coll Cardiol 51: 2355-2369 [Full Text]  
• Choi, S.-H., Prasad, A., Tsimikas, S. (2008). The evolution of thienopyridine therapy clopidogrel duration, diabetes, and drug-eluting stents.. J Am Coll Cardiol 51: 2228-2229 [Full Text]  
• Anderson, H. V. (2008). Drug-Eluting Stents: Life Insurance With a Better Death Benefit. J Am Coll Cardiol 51: 2025-2027 [Full Text]  
• Mauri, L., Normand, S.-L. T. (2008). Studies of Drug-Eluting Stents: To Each His Own?. Circulation 117: 2047-2050 [Full Text]  
• Grines, C. L., Goldstein, J. A., Safian, R. D. (2008). Should We Routinely Use Drug-Eluting Stents for Acute Myocardial Infarction?: Let's Wait and See. J Am Coll Cardiol Intv 1: 136-138 [Full Text]  
• Marso, S. P. (2008). Diabetes and Drug-Eluting Stents: What You Get and What You Don't. J Am Coll Cardiol Intv 1: 148-149 [Full Text]  
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