In patients presenting with acute myocardial infarction, treatment with drug-eluting stents is associated with decreased 2-year mortality rates and a reduction in the need for repeat revascularization procedures as compared with treatment with bare-metal stents.

Background-Drug-eluting stents (DES) reduce the need for repeat revascularization, but their long-term safety relative to that of bare-metal stents (BMS) in general use remains uncertain. We sought to compare the clinical outcome of patients treated with DES with that of BMS. Methods and Results-All adults undergoing percutaneous coronary intervention with stenting between April 1, 2003, and September 30, 2004, at non-US government hospitals in Massachusetts were identified from a mandatory state database. Patients were classified from the index admission according to stent types used. Clinical and procedural risk factors were collected prospectively. Risk-adjusted mortality, myocardial infarction, and revascularization rate differences (DESϪBMS) were estimated through propensity score matching without replacement. A total of 11 556 patients were treated with DES, and 6237 were treated with BMS, with unadjusted 2-year mortality rates of 7.0% and 12.6%, respectively (PϽ0.0001). In 5549 DES patients matched to 5549 BMS patients, 2-year risk-adjusted mortality rates were 9.8% and 12.0%, respectively (Pϭ0.0002), whereas the respective rates for myocardial infarction and target-vessel revascularization were 8.3% versus 10.3% (Pϭ0.0005) and 11.0% versus 16.8% (PϽ0.0001). Conclusions-DES treatment was associated with lower rates of mortality, myocardial infarction, and target-vessel revascularization than BMS treatment in similar patients in a matched population-based study. Comprehensive follow-up in this inclusive population is warranted to identify whether similar safety and efficacy remain beyond 2 years.

Background Insured adults receive invasive cardiovascular procedures more frequently than uninsured adults. We examined the impact of Massachusetts’s healthcare reform on use of coronary revascularization procedures, in–hospital and 1-year mortality by race/ethnicity, education, and sex. Methods and Results Using hospital claims data, we compared differences in coronary revascularization rates [coronary artery bypass grafting or percutaneous coronary intervention] and in-hospital mortality by race/ethnicity, education, and sex among Massachusetts residents age 21–64 hospitalized with a principal discharge diagnosis of ischemic heart disease pre (November 1, 2004 to July 31, 2006) and post (December 1, 2006 to September 30, 2008) reform; 1-year mortality was calculated for those undergoing revascularization. Adjusted-logistic regression assessed 24,216 discharges pre-reform and 20,721 discharges post-reform. Blacks had 30% lower odds of receiving coronary revascularization than whites in the pre-reform period. Compared to whites in the post-reform period, blacks (OR=0.73, 95%CI 0.63–0.84) and Hispanics (OR= 0.84, 95%CI 0.74–0.97) were less likely and Asians (OR=1.29, 95%CI 1.01–1.65) more likely to receive coronary revascularization. Patients living in more educated communities, males, and persons with private insurance were more likely to receive coronary revascularization pre and post-reform. Compared to pre-reform, the adjusted odds of in-hospital mortality were higher in patients living in less educated communities in the post-reform period. No differences in 1-year mortality by race/ethnicity, education, or sex for revascularized patients were observed pre- or post-reform. Conclusion Reducing insurance barriers to receipt of coronary revascularization procedures has not yet eliminated pre-existing demographic and educational disparities in access to these procedures.