Published Online
on April 7, 2008

A more recent version of this article appeared on April 22, 2008

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Submitted on July 10, 2007
Accepted on January 29, 2008

Comparison of Coronary Artery Stenting Outcomes in the Eras Before and After the Introduction of Drug-Eluting Stents

Edward L. Hannan PhD^*, Michael Racz PhD, David R. Holmes MD, Gary Walford MD, Samin Sharma MD, Stanley Katz MD, Robert H. Jones MD, and Spencer B. King III MD

From the University at Albany, State University of New York, Albany (E.L.H.); New York State Department of Health, Albany (M.R.); Mayo Clinic, Rochester, Minn (D.R.H.); St Joseph's Hospital, Syracuse, NY (G.W.); Mt Sinai Medical Center, New York, NY (S.S.); North Shore–LIJ Health System, Manhasset, NY (S.K.); Duke University Medical Center, Durham, NC (R.H.J.); and Fuqua Heart Center/Piedmont Hospital, Atlanta, Ga (S.B.K.).

^* To whom correspondence should be addressed. E-mail: elh03{at}health.state.ny.us.

Background—Few studies have compared medium-term outcomes for drug-eluting stents (DES) and bare metal stents, and most are relatively small randomized controlled trials. Furthermore, since the introduction of DES, there has been increased use and duration of use of clopidogrel, statins, and other evidence-based therapies. The purpose of the present study was to compare outcomes for patients who underwent stenting in the eras before and after the introduction of DES.

Methods and Results—New York state patients undergoing stenting in all nonfederal hospitals in the state were studied. Patients were excluded if they had a previous revascularization. Risk factors that were significant predictors of adverse outcomes were used to adjust adverse outcome rates. The study included 11 436 patients who received stents between October 1, 2002, and March 31, 2003, and 12 926 patients who underwent stenting between October 1, 2003, and March 31, 2004. Death rates, the combined end point of death and myocardial infarction (MI), nonfatal MI requiring readmission, target vessel revascularization, and target lesion revascularization were compared at 2 years. Patients in the DES era had significantly better risk-adjusted outcomes for death/MI (adjusted hazard ratio, 0.90; 95% confidence interval, 0.83 to 0.97), 9.9% versus 10.8%; nonfatal MI requiring readmission (adjusted hazard ratio, 0.86; 95% confidence interval, 0.76 to 0.97); target vessel revascularization (adjusted hazard ratio, 0.60; 95% confidence interval, 0.56 to 0.64), 11.2% versus 17.9%; and target lesion revascularization (hazard ratio, 0.55; 95% confidence interval, 0.51 to 0.59), 8.4% versus 14.7%.

Conclusions—Patients in the DES era experienced lower rates of death/MI, nonfatal MI, target vessel revascularization, and target lesion revascularization, but there were no differences in the rates of death. These improvements are likely a result of increased use of clopidogrel, statins, and dual antiplatelet therapy, in addition to the introduction of DES.

Key words: drug-eluting stents • bare metal stents • mortality • myocardial infarction • stents

Related Article:

Clinical Summaries
Circulation 2008 117: 2041. [Extract] [Full Text]

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