Abstract 4012: Drug-Eluting Stent Use Is Associated with Significant Improvements in Long-Term Clinical Outcomes
Background: Drug-eluting stents (DES) have become the principal coronary artery revascular-ization modality in the US; yet little is known about their long-term clinical outcomes versus bare-metal stents (BMS). We examined 2-year clinical event rates for BMS vs. DES in a practice-based population and compared results for patients with single- as well as multi-vessel coronary artery disease (CAD).
Methods: The study population includes Duke University Medical Center patients undergoing revascularization with BMS or DES between January 1, 2000 and May 31, 2005, with follow-up through December 31, 2005. Study outcomes examined are death, non-fatal myocardial infarction (MI), and target vessel revascularization (TVR), and their composites.
Results: We examined the data of 3675 BMS and 1513 DES patients. DES vs. BMS patients had less single- (57.6% vs. 63.3%) and more multi-vessel CAD (42.5% vs. 36.7%). At two years follow-up, DES vs. BMS patients had lower rates of mortality (8.2% vs. 8.6%), non-fatal MI (4.7% vs. 5.0%), and TVR (9.4% vs. 14.5%). This difference in DES vs. BMS TVR rate was observed in patients with one- (8.6% vs. 13.0%), two- (9.9% vs. 16.8%), and three-vessel CAD (13.8% vs. 19.2%). After adjustment for differences in baseline characteristics using Cox proportional hazards modeling, DES vs. BMS use was associated with no difference in mortality (HR = 0.964, 95% CI = 0.709, 1.309); but with significant reductions in the composites of death or MI (HR = 0.711, 95% CI = 0.541, 0.934) and death, MI, or TVR (HR = 0.569, 95% CI = 0.447, 0.723). There were no interactions between stent type and number of diseased vessels in any of the adjusted models, signifying that event reduction is not limited to 1-, 2-, or 3-vessel CAD patients.
Conclusions: The use of drug-eluting vs. bare-metal stents is associated with significant improvements in long-term clinical outcomes for patients with single- and multi-vessel coronary artery disease.