Comparison of Effectiveness of Bare Metal Stents Versus Drug-Eluting Stents in Large (≥3.5 mm) Coronary Arteries

Steinberg, Daniel; Mishra, Sundeep; Javaid, Aamir; Slottow, Tina L. Pinto; Buch, Ashesh N.; Roy, Probal; Okabe, Teruo; Smith, Kimberly A.; Torguson, Rebecca; Zhang, Xue; Pichard, Augusto D.; Satler, Lowell F.; Kent, Kenneth M.; Suddath, William O.; Waksman, Ron

doi:10.1016/j.amjcard.2006.09.105

Cited by 55 publications

(43 citation statements)

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“…The benefit over BMS is marked in some patient subgroups and lesion subsets and is less pronounced or absent in others [6][7][8][9][10][11] . Use of multiple stents, vessel diameter and diabetes have long been identified as predictors of restenosis after stent implantation 12 .…”

Section: Introductionmentioning

confidence: 99%

Selective use of contemporary drug-eluting stents in primary angioplasty for ST-elevation myocardial infarction: pooled analysis of COMFORTABLE AMI and EXAMINATION

Baumbach

Heg²,

Räber³

et al. 2017

EuroIntervention

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Aims: Selective use of DES only in patients at higher risk of MACE is common practice, particularly in healthcare systems with a large premium payable for DES. We aimed to identify subgroups of patients in which the use of BMS in primary percutaneous coronary intervention (PPCI) for STEMI can still be justified.Methods and results: We performed a patient-level pooled analysis of COMFORTABLE AMI and EXAMINATION comparing contemporary DES with BMS in PPCI. A risk score was applied using three parameters: lesion length >15 mm, vessel size <3 mm, and diabetes mellitus. Individual data were available for 2,655 patients. The incidence of MACE at one year was incrementally higher in patients with risk scores of 1 or 2/3. MACE rates were lower in patients with a risk score 0 or 1 who were treated with DES (p=0.0073 and p=0.008). No difference in death or reinfarction was seen between DES and BMS in any group. There was a significant reduction in TLR with DES in all three groups.Conclusions: A score comprising vessel size, lesion length, and diabetes did not identify patients at low risk with equivalent or better results from BMS use. The results suggest that the practice of only selective use of DES in primary PCI should be discouraged. KEYWORDS• drug-eluting stents • primary angioplasty • STEMI

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Section: Introductionmentioning

confidence: 99%

Selective use of contemporary drug-eluting stents in primary angioplasty for ST-elevation myocardial infarction: pooled analysis of COMFORTABLE AMI and EXAMINATION

Baumbach

Heg²,

Räber³

et al. 2017

EuroIntervention

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“…The inverse relationship between vessel size and restenosis rate following BMS implantation [26] may explain the equal efficacy between BMS and DES implants as reported in previous studies on large coronary artery lesions. A series of previous studies showed no significant differences in the rate of TLR and MACE between BMS and DES in patients requiring large coronary stents [15,[17][18][19]. However, follow-up periods in these studies seemed to be relatively short to support their conclusions, because the late catch-up phenomenon and very late stent thrombosis could occur more than 1 year after stent implantation.…”

Section: Discussionmentioning

confidence: 44%

“…Furthermore, many DES trials excluded patients with larger arteries. So far, there have been a few retrospective subgroup analyses or registries of large vessel stenting (≥ 3.5 mm) and only some studies have analyzed the clinical outcome of DES and BMS in large-size coronary arteries [15][16][17][18][19]. These studies didn't seem to conclusively address the problem.…”

Section: Introductionmentioning

confidence: 91%

Drug-Eluting vs. Bare-Metal Stents: Is it a Matter of Vessel Size?

Boussaada¹,

Hassine²,

Messaoud³

et al. 2017

J Clin Trials

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“…7 Restenosis rates are quite low in large arteries after bare-metal stent (BMS) implantation. 3,8 -11 Steinberg et al 12 reported that patients treated with ≥3.5 mm DES and BMS had similar low incidence of MACE and target-lesion revascularization (TLR) and TVR in both groups, with no superiority of DES over BMS in this lesion. Quizhpe et al 13 showed excellent 1-year clinical outcomes after large vessel (>3 mm) PCI between DES and BMS.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Angiographic Outcomes of Drug‐Eluting Stents in Patients With Large Vessel and Single Coronary Artery Lesion

Kim

Seol

et al. 2010

Clinical Cardiology

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Background: The aim of this study was to evaluate and compare the clinical and angiographic outcomes of 3 drug-eluting stents (DES) in patients with large vessel diameter and single coronary artery lesions. Hypothesis: The efficacy of 3 DESs may be similar. Methods: A total of 411 consecutive patients who visited 3 university hospitals from June 2004 to December 2007 and had a single coronary lesion which was treated with the use of a DES that was 3.5 mm in diameter were enrolled in this study. Patients were divided into 3 stent groups: Paclitaxel-eluting stent (PES, n = 105), Sirolimus-eluting stent (SES, n = 259), and Zotarolimus-eluting stent (ZES, n = 47). The study end point was a composite of major adverse cardiac events (MACE) including cardiac death, myocardial infarction (MI), and ischemia-driven target-vessel revascularization (TVR) for 12 months. Results: Baseline characteristics were not different. Late loss was higher in the ZES group than the other stents (0.5 ± 0.4 mm in SES vs 0.3 ± 0.5 mm in PES, 0.7 ± 0.5 mm in ZES, P = 0.001). The total MACE-free survival rate was not significantly different between the SES group and the PES group (98.8% in SES vs 97.1% in PES, P = 0.252) or the PES group and the ZES group (97.1% in PES vs 93.6% in ZES, P = 0.301). However, the SES group showed a significantly better MACE-free survival rate compared with the ZES group (98.8% in SES vs 93.6% in ZES, P = 0.018). Conclusions: Clinical and angiographic outcomes of DES in a large vessel diameter and single coronary artery is excellent and SES appears to show better angiographic and clinical outcomes than ZES. IntroductionDrug-eluting stents (DES) have shown great efficacy in the reduction of restenosis compared with bare-metal stents (BMS). 1 However, the advent of safety and cost concerns shakes the firm position of DESs in a wide range of coronary lesions and patient subsets. The benefits of DESs were confined to lesions <3.0 mm. 2 Although there were several randomized studies and other large registries comparing DES and BMS, 2 -5 no data was reported comparing the different DESs.We seek to evaluate and compare the clinical and angiographic outcomes of 3 different DESs in patients with large vessel diameter and single coronary artery lesion.

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Comparison of Effectiveness of Bare Metal Stents Versus Drug-Eluting Stents in Large (≥3.5 mm) Coronary Arteries

Cited by 55 publications

References 13 publications

Selective use of contemporary drug-eluting stents in primary angioplasty for ST-elevation myocardial infarction: pooled analysis of COMFORTABLE AMI and EXAMINATION

Selective use of contemporary drug-eluting stents in primary angioplasty for ST-elevation myocardial infarction: pooled analysis of COMFORTABLE AMI and EXAMINATION

Drug-Eluting vs. Bare-Metal Stents: Is it a Matter of Vessel Size?

Clinical and Angiographic Outcomes of Drug‐Eluting Stents in Patients With Large Vessel and Single Coronary Artery Lesion

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