Bare-metal stent outcomes in an unselected patient population

Abstract

SummaryBackground: Randomized trials have shown that drug-eluting stents (DES) substantially reduce in-stent restenosis compared with bare-metal stents (BMS).Hypothesis: Revascularization event rates related to BMS restenosis may be higher in the trials setting than in real-world experience, calling into question the extent of benefit possible with widespread DES use in regular practice.Methods: Between December 1998 and March 2003, 17,102 patients with BMS registered in the Goodroe Healthcare Solutions Data Warehouse met the inclusion criteria for this retrospective study of catheterization laboratory data. We examined the database for evidence of diagnostic angiography or percutaneous coronary intervention (PCI) readmission within 1 year after stenting.Results: Repeat PCI was documented for 2,070 patients, and 232 were referred for coronary artery bypass graft surgery (CABG)-in sum, 13.5% of the cohort. Stented region revascularization was observed in 8.4%: 1,350 patients underwent subsequent PCI, and 84 of the patients referred for CABG had in-stent lesion recurrence. Only 1,207 (7.1%) patients required stent-related PCI after 30 days, the time frame consistent with restenosis.Conclusions: In this "real-world" series, reintervention of a stented region after the first follow-up month was documented in fewer than 8% of patients in a large cohort that had received BMS. The rate of clinical events potentially related to BMS instent restenosis in this large, unselected patient population is substantially lower than that in the control arms of some DES trials. The incremental benefit of widespread conversion from

Repeat intervention after invasive treatment of coronary arteries☆

“…Although PCI with stenting has substantially improved the safety and long-term efficacy of the revascularisation of coronary arteries [12][13][14], it is still associated with a greater need for repeat revascularisation [2,9,15]. The results of the present study concur with those of earlier reports.…”

As Time Goes By

“…It has been argued that the clinical benefits of DES relative to restenosis and target vessel revascularization (TVR) have been overestimated in clinical trials compared with clinical practice (2)(3)(4). This might be a consequence of several factors: 1) the use of thick-strut stents in the former versus thin-strut stents in the latter; 2) protocol-driven angiography mandated in the former, which inflates restenosis rates by about 2-fold; and 3) attenuation of restenosis benefit in high-risk patients (diabetes, acute coronary syndromes, and renal failure) and complex lesions (multivessel disease, arterial bifurcations, left main disease, chronic total occlusions, and vein grafts) that were not evaluated in the pivotal clinical trials but represent Ͼ60% of patients undergoing stenting in clinical practice (2) ( Table 1).…”

Five-Year Follow-Up of the Medicine, Angioplasty, or Surgery Study (MASS-II)

“…Observation from a large database of patients receiving bare-metal stents shows a 1-year reintervention rate well below 10%. 17 The number of reinterventions avoided per 100 patients with drug-eluting stents has been estimated to be about 5. The comparison of drug-eluting stenting in multivessel disease patients versus previous bare-metal stenting is, however, very encouraging.…”