Comparison of outcome in 1809 patients treated with drug-eluting stents or bare-metal stents in a real-world setting

Alexander Vogt¹, Anke Schoelmerich¹, Franziska Pollner¹, Manuela Schlitt¹, Uwe Raaz¹, Lars Maegdefessel², Iris Reindl¹, Michael Buerke¹, Karl Werdan¹, Axel Schlitt^1
1Department of Medicine III, Martin Luther-University, Halle, Germany; ²Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA

Purpose: The aim of this study was to determine the long-term safety of drug-eluting stent (DES) versus bare metal stent (BMS) implantation in a “real-world” setting.
Patients and methods: A total of 1809 patients who were treated with implantation of either BMS or DES were assessed. Kaplan-Meier and multivariate Cox regression analyses concerning primary endpoint of cardiac mortality were performed.
Results: A total of 609 patients received DES. Mean age was 66.2 ± 11.3 years, 69.4% were male, and 1517 (83.8%) were treated for acute coronary syndrome (unstable angina 510 [28.2%], non-ST-elevation myocardial infarction [NSTEMI] 506 [28.0%], and ST-elevation myocardial infarction [STEMI] 501 [27.7%]). Mean follow-up was 34 ± 15 months. During follow-up, 268 patients died of cardiac causes (DES 42 [7.3%]; BMS 226 [19.6%]; P < 0.001). Univariate Kaplan-Meier analysis showed an advantage of DES over BMS concerning the primary endpoint (P < 0.001). When adjusting for classic risk factors and additional factors that affect the progression of coronary heart disease (CHD), DES was not found to be superior to BMS (hazard ratio 0.996, 95% confidence interval 0.455–2.182, P = 0.993). Severely impaired renal function was an independent predictor for cardiac mortality after stent implantation.
Conclusion: Treatment with DES is safe in the long term, also in patients presenting with STEMI. However, in multivariate analyses it is not superior to BMS treatment.

Keywords: coronary stent, outcome, renal insufficiency, myocardial infarction, STEMI