Abstract 1948: Variations in Time to Repeat Revascularization with Drug Eluting Stents compared to Bare Metal Stents: A Report from the NHLBI Dynamic Registry of PCI
Drug Eluting Stents (DES) decrease the need for repeat percutaneous coronary intervention (PCI). However, the differences in temporal characteristics of the presentation of those requiring repeat PCI after receiving a DES compared to bare metal stent (BMS) is not well established. Accordingly, we evaluated the differences in mean time to clinically driven repeat PCI in patients receiving a DES vs BMS in the NHLBI Dynamic Registry. This analysis consisted of 1997 (23.8%) patients who had a major cardiovascular event at 1-year (MCE, a composite of death, MI, and repeat PCI) out of 5134 subjects that received a BMS during waves 1–3 of the Dynamic Registry (1997–2001), and of 220 (16.5%) patients who had an MCE out of 1460 subjects who received a DES during wave 4 (2004). Patients in the DES group were younger, had more co-morbid conditions, such as diabetes, renal dysfunction, and multivessel disease, when compared to those in the BMS group. The DES group received more aggressive medical therapy. There were no differences between groups in procedural indications, angiographic success, or 1-year rates of death and MI. The mean time to 1-year repeat PCI was significantly lengthened in the DES group, compared to the BMS group (180.4 ± 101.2 vs 150.7 ± 88.9 days, p < 0.01). While 70% of repeat PCI in the BMS group occurred in the first 6 months, the pattern of repeat PCI in the DES group was more evenly distributed over the 1-year follow-up (figure⇓). This study suggests that while DES reduce the overall need for repeat PCI, there are temporal differences in the time to repeat PCI in the DES era compared with the BMS era. These findings may have important implications in patient care and clinical trial design.