Four-Year Outcomes Compare DES With BMS for Stable CAD

July 1, 2010—In Catheterization and Cardiovascular Interventions, Cihan Simsek, MD, et al have published 4-year clinical outcomes of sirolimus- (SES) and paclitaxel-eluting stents (PES) compared to bare-metal stents (BMS) for the percutaneous treatment of stable coronary artery disease (CAD) (2010;76:41–49).

According to the investigators, there are limited data on the long-term safety and efficacy profile of coronary stent implantation in patients with stable CAD undergoing percutaneous coronary intervention (PCI). Therefore, the objective of this single-center study was to assess the 4-year clinical outcomes of patients who received a BMS, SES, or PES for the percutaneous treatment of stable angina at the Thoraxcenter of Erasmus Medical Center in Rotterdam, The Netherlands between 2000 and 2005.

During the study period, a total of 2,449 consecutive patients (BMS = 1,005, SES = 373, and PES = 1,071) underwent PCI as part of three historical PCI cohorts for stable angina and were routinely followed for the occurrence of major adverse cardiac events (MACE).

The investigators reported that at 4-year follow-up, 264 BMS patients (26.8%) experienced MACE compared to 75 SES patients (20.9%) and 199 PES patients (23.9%). Multivariate analysis showed that SES and PES were superior to BMS with respect to MACE (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.47–0.81; and HR, 0.67; 95% CI, 0.550.82, respectively). The occurrence of MACE was significantly lower in the SES and PES population, primarily due to less target vessel revascularization (TVR) procedures (HR, 0.53; 95% CI, 0.37–0.75; and HR, 0.71; 95% CI, 0.62–0.81, respectively). The occurrence of early, late, and very late stent thrombosis was equally rare with each stent type. There were no significant differences between SES and PES for death, myocardial infarction, TVR, and MACE.

These findings suggest that SES and PES result in decreased TVR procedures and MACE compared to BMS at 4-year follow-up; therefore, SES or PES implantation should be the preferred choice over BMS for patients with stable CAD undergoing PCI, the investigators concluded.