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Previous Volume 358:342-352 January 24, 2008 Number 4 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set CME Exam Editorial by Carrozza, J. P. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Recent reports suggest that off-label use of drug-eluting stents is associated with an increased incidence of adverse events. Whether the use of bare-metal stents would yield different results is unknown.

Methods We analyzed data from 6551 patients in the National Heart, Lung, and Blood Institute Dynamic Registry according to whether they were treated with drug-eluting stents or bare-metal stents and whether use was standard or off-label. Patients were followed for 1 year for the occurrence of cardiovascular events and death. Off-label use was defined as use in restenotic lesions, lesions in a bypass graft, left main coronary artery disease, or ostial, bifurcated, or totally occluded lesions, as well as use in patients with a reference-vessel diameter of less than 2.5 mm or greater than 3.75 mm or a lesion length of more than 30 mm.

Results Off-label use occurred in 54.7% of all patients with bare-metal stents and 48.7% of patients with drug-eluting stents. As compared with patients with bare-metal stents, patients with drug-eluting stents had a higher prevalence of diabetes, hypertension, renal disease, previous percutaneous coronary intervention and coronary-artery bypass grafting, and multivessel coronary artery disease. One year after intervention, however, there were no significant differences in the adjusted risk of death or myocardial infarction in patients with drug-eluting stents as compared with those with bare-metal stents, whereas the risk of repeat revascularization was significantly lower among patients with drug-eluting stents.

Conclusions Among patients with off-label indications, the use of drug-eluting stents was not associated with an increased risk of death or myocardial infarction but was associated with a lower rate of repeat revascularization at 1 year, as compared with bare-metal stents. These findings support the use of drug-eluting stents for off-label indications.

Source Information

From the Cardiovascular Institute (O.C.M., S.R.M., J.S.L., C.S., W.D.A.) and the Department of Epidemiology, Graduate School of Public Health (F.S., H.A.V., S.F.K.), University of Pittsburgh, Pittsburgh; Rhode Island Hospital, Providence (D.O.W., J.D.A.); Hospital of the University of Pennsylvania, Philadelphia (R.L.W.); Montreal Heart Institute, Montreal (J.-F.T.); University of Texas Southwestern Medical Center, Dallas (E.M.H.); and University of South Florida, Tampa (K.E.K.).

Address reprint requests to Dr. Marroquin at the Cardiovascular Institute, University of Pittsburgh Medical Center, 200 Lothrop St., F392, PUH, Pittsburgh, PA 15213, or at marroquinoc{at}upmc.edu.

Full Text of this Article

Related Letters:

Bare-Metal versus Drug-Eluting Coronary Stents
Austin D., Pell J. P., Oldroyd K. G., Agostoni P., Vermeersch P., Marroquin O. C., Mulukutla S. R., Kip K. E.
Extract | Full Text | PDF  
N Engl J Med 2008; 358:2516-2518, Jun 5, 2008. Correspondence

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