This Article Figures Only Full Text Full Text (PDF) View Online Appendix View TALK BACK Discussion View Cardiosource Slide Set All Versions of this Article: j.jacc.2007.07.071v1 50/21/2029    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Abbott, J. D. Articles by Williams, D. O. Search for Related Content PubMed PubMed Citation Articles by Abbott, J. D. Articles by Williams, D. O. Related Collections Related Articles

CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Unrestricted Use of Drug-Eluting Stents Compared With Bare-Metal Stents in Routine Clinical Practice

Findings From the National Heart, Lung, and Blood Institute Dynamic Registry

J. Dawn Abbott, MD, FACC^_*,_*, Matthew R. Voss, MD^_*, Mamoo Nakamura, MD, Howard A. Cohen, MD, FACC, Faith Selzer, PhD, Kevin E. Kip, PhD,, Helen A. Vlachos, MSc, Robert L. Wilensky, MD, FACC and David O. Williams, MD, FACC^_*

^_* Department of Cardiology, Rhode Island Hospital, Providence, Rhode Island
Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
Lenox Hill Heart and Vascular Institute, New York, New York
Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania

Manuscript received February 16, 2007; revised manuscript received June 27, 2007, accepted July 2, 2007.

^_* Reprint requests and correspondence: Dr. J. Dawn Abbott, Rhode Island Hospital, 814 APC, 593 Eddy Street, Providence, Rhode Island 02903. (Email: jabbott{at}lifespan.org).

Objectives: We investigated the effectiveness and safety of drug-eluting stents (DES) as used in routine clinical practice.

Background: Randomized trials have shown that DES prevent target vessel revascularization in selected patients, but whether this translates into superior outcomes, compared with bare-metal stents (BMS), for the full spectrum of patients treated with DES in North America is unknown.

Methods: Patients in the National Heart, Lung, and Blood Institute Dynamic Registry enrolled in 2004 who received at least 1 DES (n = 1,460) were compared with 1,763 patients enrolled in the recruitment period immediately preceding the approval of DES (2001 to 2002) who received at least 1 BMS.

Results: Patients receiving DES more often had diabetes mellitus and less often presented with an acute myocardial infarction (MI). At 1 year, cumulative death and MI was 7.6% in DES- and 8.7% in BMS-treated patients (adjusted hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.68 to 1.15; p = 0.34). The 1-year rate of target vessel revascularization was 5.0% in DES and 9.2% in BMS patients (p < 0.001), and the risk of any repeat revascularization by percutaneous coronary intervention or coronary bypass was lower in DES patients (adjusted HR 0.38, 95% CI 0.25 to 0.60; p < 0.001). Patients with both simple and complex lesion characteristics benefited from DES with lower risk of repeat target vessel revascularization by percutaneous coronary intervention compared with BMS (any complex lesion: adjusted HR 0.57, 95% CI 0.39 to 0.83; absence of any complex lesion: adjusted HR 0.44, 95% CI 0.28 to 0.71). The 1-year incidence of stent thrombosis was 1.0% in DES patients.

Conclusions: The generalized use of DES resulted in better outcomes than BMS, with fewer clinically driven revascularization procedures and similar rates of death and MI at 1 year.

Abbreviations and Acronyms   BMS = bare metal stent(s)   DES = drug-eluting stent(s)   HR = hazard ratio   MACE = major adverse cardiac events   MI = myocardial infarction   PCI = percutaneous coronary intervention

Related Articles

Inside This Issue of JACC
J. Am. Coll. Cardiol. 2007 50: A31-A32. [Full Text] [PDF]

This article has been cited by other articles:

				L. Venkitachalam, Y. Lei, E. A. Magnuson, P. S. Chan, J. M. Stolker, K. F. Kennedy, N. S. Kleiman, D. J. Cohen, and on behalf of the EVENT Registry Investigators Survival Benefit With Drug-Eluting Stents in Observational Studies: Fact or Artifact? Circ Cardiovasc Qual Outcomes, November 1, 2011; 4(6): 587 - 594. [Abstract] [Full Text] [PDF]

				R. Llano, D. Winsor-Hines, D. B. Patel, P. S. Seifert, D. Hamamdzic, G. J. Wilson, H. Wang, M. G. Keane, B. A. Huibregtse, and R. L. Wilensky Vascular Responses to Drug-Eluting and Bare Metal Stents in Diabetic/Hypercholesterolemic and Nonatherosclerotic Porcine Coronary Arteries Circ Cardiovasc Interv, October 1, 2011; 4(5): 438 - 446. [Abstract] [Full Text] [PDF]

				L. Venkitachalam, Y. Lei, J. M. Stolker, E. M. Mahoney, A. P. Amin, J. B. Lindsey, K. F. Kennedy, M. J. Pencina, J. J. Lopez, N. S. Kleiman, et al. Clinical and Economic Outcomes of Liberal Versus Selective Drug-Eluting Stent Use: Insights From Temporal Analysis of the Multicenter Evaluation of Drug Eluting Stents and Ischemic Events (EVENT) Registry Circulation, August 30, 2011; 124(9): 1028 - 1037. [Abstract] [Full Text] [PDF]

				K. Fujii, D. Kawasaki, K. Oka, H. Akahori, M. Fukunaga, H. Sawada, M. Masutani, M. Lee-Kawabata, T. Tsujino, M. Ohyanagi, et al. Endothelium-dependent coronary vasomotor response and neointimal coverage of zotarolimus-eluting stents 3 months after implantation Heart, June 15, 2011; 97(12): 977 - 982. [Abstract] [Full Text] [PDF]

				T.-H. Chen and R. Matyal The Management of Antiplatelet Therapy in Patients With Coronary Stents Undergoing Noncardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2010; 14(4): 256 - 273. [Abstract] [PDF]

				J. S. Rana, L. Venkitachalam, F. Selzer, S. R. Mulukutla, O. C. Marroquin, W. K. Laskey, E. M. Holper, V. S. Srinivas, K. E. Kip, S. F. Kelsey, et al. Evolution of Percutaneous Coronary Intervention in Patients with Diabetes: A report from the National Heart, Lung, and Blood Institute-sponsored PTCA (1985-1986) and Dynamic (1997-2006) Registries Diabetes Care, September 1, 2010; 33(9): 1976 - 1982. [Abstract] [Full Text] [PDF]

				S. Shirai, T. Kimura, M. Nobuyoshi, T. Morimoto, K. Ando, Y. Soga, K. Yamaji, K. Kondo, K. Sakai, T. Arita, et al. Impact of Multiple and Long Sirolimus-Eluting Stent Implantation on 3-Year Clinical Outcomes in the j-Cypher Registry J. Am. Coll. Cardiol. Intv., February 1, 2010; 3(2): 180 - 188. [Abstract] [Full Text] [PDF]

				J. A. Ladapo, F. A. Jaffer, U. Hoffmann, C. C. Thomson, F. Bamberg, W. Dec, D. M. Cutler, M. C. Weinstein, and G. S. Gazelle Clinical Outcomes and Cost-Effectiveness of Coronary Computed Tomography Angiography in the Evaluation of Patients With Chest Pain J. Am. Coll. Cardiol., December 15, 2009; 54(25): 2409 - 2422. [Abstract] [Full Text] [PDF]

				J. Carlsson, S. K. James, J. Lindback, F. Schersten, T. Nilsson, U. Stenestrand, B. Lagerqvist, and for the SCAAR (Swedish Coronary Angiography and An Outcome of Drug-Eluting Versus Bare-Metal Stenting Used According to On- and Off-Label Criteria J. Am. Coll. Cardiol., April 21, 2009; 53(16): 1389 - 1398. [Abstract] [Full Text] [PDF]

				P. Garg, S.-L. T. Normand, T. S. Silbaugh, R. E. Wolf, K. Zelevinsky, A. Lovett, M. R. Varma, Z. Zhou, and L. Mauri Drug-Eluting or Bare-Metal Stenting in Patients With Diabetes Mellitus: Results From the Massachusetts Data Analysis Center Registry Circulation, November 25, 2008; 118(22): 2277 - 2285. [Abstract] [Full Text] [PDF]

				L. Mauri, T. S. Silbaugh, R. E. Wolf, K. Zelevinsky, A. Lovett, Z. Zhou, F. S. Resnic, and S.-L. T. Normand Long-Term Clinical Outcomes After Drug-Eluting and Bare-Metal Stenting in Massachusetts Circulation, October 28, 2008; 118(18): 1817 - 1827. [Abstract] [Full Text] [PDF]

				M. H. Shishehbor, S. S. Goel, S. R. Kapadia, D. L. Bhatt, P. Kelly, R. E. Raymond, J. M. Galla, S. J. Brener, P. L. Whitlow, and S. G. Ellis Long-Term Impact of Drug-Eluting Stents Versus Bare-Metal Stents on All-Cause Mortality J. Am. Coll. Cardiol., September 23, 2008; 52(13): 1041 - 1048. [Abstract] [Full Text] [PDF]

				A. J. Kirtane and D. J. Cohen When Is Better Not Good Enough?: Insights From the COURAGE Economic Study Circ Cardiovasc Qual Outcomes, September 1, 2008; 1(1): 4 - 6. [Full Text] [PDF]

				J. D. Abbott Revealing the Silver and Red Lining in Drug-Eluting Stents With Angioscopy Circ Cardiovasc Interv, August 1, 2008; 1(1): 7 - 9. [Full Text] [PDF]

				B. R. Brodie, T. Stuckey, W. Downey, A. Humphrey, B. Bradshaw, C. Metzger, J. Hermiller, F. Krainin, S. Juk, B. Cheek, et al. Outcomes and Complications With Off-Label Use of Drug-Eluting Stents: Results From the STENT (Strategic Transcatheter Evaluation of New Therapies) Group J. Am. Coll. Cardiol. Intv., August 1, 2008; 1(4): 405 - 414. [Abstract] [Full Text] [PDF]

				S. R. Dixon, C. L. Grines, and W. W. O'Neill The Year in Interventional Cardiology J. Am. Coll. Cardiol., June 17, 2008; 51(24): 2355 - 2369. [Full Text] [PDF]

				L. Mauri and S.-L. T. Normand Studies of Drug-Eluting Stents: To Each His Own? Circulation, April 22, 2008; 117(16): 2047 - 2050. [Full Text] [PDF]

				C. L. Grines, J. A. Goldstein, and R. D. Safian Should We Routinely Use Drug-Eluting Stents for Acute Myocardial Infarction?: Let's Wait and See J. Am. Coll. Cardiol. Intv., April 1, 2008; 1(2): 136 - 138. [Full Text] [PDF]

				A. N. DeMaria, J. J. Bax, O. Ben-Yehuda, P. Clopton, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, J. D. Knoke, W. Y.W. Lew, J. A.C. Lima, et al. Highlights of the Year in JACC 2007 J. Am. Coll. Cardiol., January 29, 2008; 51(4): 490 - 512. [Full Text] [PDF]

				In Clinical Practice, Drug-Eluting Stents Outperform Bare-Metal Stents Journal Watch Cardiology, December 26, 2007; 2007(1226): 5 - 5. [Full Text]

				H. J. Buttner and F.-J. Neumann Peeling-Off Labels: Mounting Evidence for Benefit of Drug-Eluting Stents With Off-Label Use J. Am. Coll. Cardiol., November 20, 2007; 50(21): 2037 - 2038. [Full Text] [PDF]