OBJECTIVES: The aim of this study was to compare outcomes in older individuals receiving drug-eluting stents (DES) and bare-metal stents (BMS). BACKGROUND: Comparative effectiveness of DES relative to BMS remains unclear. METHODS: Outcomes were evaluated in 262,700 patients from 650 National Cardiovascular Data Registry sites during 2004 to 2006 with procedural registry data linked to Medicare claims for follow-up. Outcomes including death, myocardial infarction (MI), revascularization, major bleeding, stroke, death or MI, death or MI or revascularization, and death or MI or stroke were compared with estimated cumulative incidence rates with inverse probability weighted estimators and Cox proportional hazards ratios. RESULTS: The DES were implanted in 217,675 patients and BMS were implanted in 45,025. At 30 months, DES patients had lower unadjusted rates of death (12.9% vs. 17.9%), MI (7.3 of 100 patients vs. 10.0 of 100 patients), and revascularization (23.0 of 100 patients vs. 24.5 of 100 patients) with no difference in stroke or bleeding. After adjustment, DES patients had lower rates of death (13.5% vs. 16.5%, hazard ratio [HR]: 0.75, 95% confidence interval [CI]: 0.72 to 0.79, p < 0.001) and MI (7.5 of 100 patients vs. 8.9 of 100 patients, HR: 0.77, 95% CI: 0.72 to 0.81, p < 0.001), with minimal difference in revascularization (23.5 of 100 patients vs. 23.4 of 100 patients; HR: 0.91, 95% CI: 0.87 to 0.96), stroke (3.1 of 100 patients vs. 2.7 of 100 patients, HR: 0.97, 95% CI: 0.88 to 1.07), or bleeding (3.4 of 100 patients vs. 3.6 of 100 patients, HR: 0.91, 95% CI: 0.84 to 1.00). The DES survival benefit was observed in all subgroups analyzed and persisted throughout 30 months of follow-up. CONCLUSIONS: In this largest ever real-world study, patients receiving DES had significantly better clinical outcomes than their BMS counterparts, without an associated increase in bleeding or stroke, throughout 30 months of follow-up and across all pre-specified subgroups.
OBJECTIVES: The aim of this study was to compare outcomes in older individuals receiving drug-eluting stents (DES) and bare-metal stents (BMS). BACKGROUND: Comparative effectiveness of DES relative to BMS remains unclear. METHODS: Outcomes were evaluated in 262,700 patients from 650 National Cardiovascular Data Registry sites during 2004 to 2006 with procedural registry data linked to Medicare claims for follow-up. Outcomes including death, myocardial infarction (MI), revascularization, major bleeding, stroke, death or MI, death or MI or revascularization, and death or MI or stroke were compared with estimated cumulative incidence rates with inverse probability weighted estimators and Cox proportional hazards ratios. RESULTS: The DES were implanted in 217,675 patients and BMS were implanted in 45,025. At 30 months, DESpatients had lower unadjusted rates of death (12.9% vs. 17.9%), MI (7.3 of 100 patients vs. 10.0 of 100 patients), and revascularization (23.0 of 100 patients vs. 24.5 of 100 patients) with no difference in stroke or bleeding. After adjustment, DESpatients had lower rates of death (13.5% vs. 16.5%, hazard ratio [HR]: 0.75, 95% confidence interval [CI]: 0.72 to 0.79, p < 0.001) and MI (7.5 of 100 patients vs. 8.9 of 100 patients, HR: 0.77, 95% CI: 0.72 to 0.81, p < 0.001), with minimal difference in revascularization (23.5 of 100 patients vs. 23.4 of 100 patients; HR: 0.91, 95% CI: 0.87 to 0.96), stroke (3.1 of 100 patients vs. 2.7 of 100 patients, HR: 0.97, 95% CI: 0.88 to 1.07), or bleeding (3.4 of 100 patients vs. 3.6 of 100 patients, HR: 0.91, 95% CI: 0.84 to 1.00). The DES survival benefit was observed in all subgroups analyzed and persisted throughout 30 months of follow-up. CONCLUSIONS: In this largest ever real-world study, patients receiving DES had significantly better clinical outcomes than their BMS counterparts, without an associated increase in bleeding or stroke, throughout 30 months of follow-up and across all pre-specified subgroups.
Authors: R G Brindis; S Fitzgerald; H V Anderson; R E Shaw; W S Weintraub; J F Williams Journal: J Am Coll Cardiol Date: 2001-06-15 Impact factor: 24.094
Authors: Eugène P McFadden; Eugenio Stabile; Evelyn Regar; Edouard Cheneau; Andrew T L Ong; Timothy Kinnaird; William O Suddath; Neil J Weissman; Rebecca Torguson; Kenneth M Kent; August D Pichard; Lowell F Satler; Ron Waksman; Patrick W Serruys Journal: Lancet Date: 2004 Oct 23-29 Impact factor: 79.321
Authors: Sunil V Rao; Richard E Shaw; Ralph G Brindis; Lloyd W Klein; William S Weintraub; Ronald J Krone; Eric D Peterson Journal: Am Heart J Date: 2006-08 Impact factor: 4.749
Authors: Steven R Steinhubl; Peter B Berger; J Tift Mann; Edward T A Fry; Augustin DeLago; Charles Wilmer; Eric J Topol Journal: JAMA Date: 2002-11-20 Impact factor: 56.272
Authors: Gregg W Stone; Stephen G Ellis; David A Cox; James Hermiller; Charles O'Shaughnessy; James Tift Mann; Mark Turco; Ronald Caputo; Patrick Bergin; Joel Greenberg; Jeffrey J Popma; Mary E Russell Journal: N Engl J Med Date: 2004-01-15 Impact factor: 91.245
Authors: Jeffrey W Moses; Martin B Leon; Jeffrey J Popma; Peter J Fitzgerald; David R Holmes; Charles O'Shaughnessy; Ronald P Caputo; Dean J Kereiakes; David O Williams; Paul S Teirstein; Judith L Jaeger; Richard E Kuntz Journal: N Engl J Med Date: 2003-10-02 Impact factor: 91.245
Authors: David Austin; Keith G Oldroyd; Alex McConnachie; Rachel Slack; Hany Eteiba; Andrew D Flapan; Kevin P Jennings; Robin J Northcote; Alastair C H Pell; Ian R Starkey; Jill P Pell Journal: Circ Cardiovasc Interv Date: 2008-08 Impact factor: 6.546
Authors: William S Weintraub; Maria V Grau-Sepulveda; Jocelyn M Weiss; Elizabeth R Delong; Eric D Peterson; Sean M O'Brien; Paul Kolm; Lloyd W Klein; Richard E Shaw; Charles McKay; Laura L Ritzenthaler; Jeffrey J Popma; John C Messenger; David M Shahian; Frederick L Grover; John E Mayer; Kirk N Garratt; Issam D Moussa; Fred H Edwards; George D Dangas Journal: Circulation Date: 2012-02-23 Impact factor: 29.690
Authors: Marleen M J Ploegmakers; Anneke M Viscaal; Lois Finch; Nancy E Mayo; James M Brophy Journal: Can J Cardiol Date: 2010 Jun-Jul Impact factor: 5.223
Authors: Kevin R Bainey; Faith Selzer; Howard A Cohen; Oscar C Marroquin; Elizabeth M Holper; Michelle M Graham; David O Williams; David P Faxon Journal: Am J Cardiol Date: 2011-10-14 Impact factor: 2.778
Authors: S Michael Gharacholou; Renato D Lopes; Jeffrey B Washam; L Kristin Newby; Stefan K James; John H Alexander Journal: J Thromb Thrombolysis Date: 2010-05 Impact factor: 2.300
Authors: Jerome J Federspiel; Sally C Stearns; Brett C Sheridan; Jack J Kuritzky; Laura P D'Arcy; Daniel J Crespin; Timothy S Carey; Joseph S Rossi Journal: Am Heart J Date: 2012-08 Impact factor: 4.749
Authors: Fred H Edwards; David M Shahian; Maria V Grau-Sepulveda; Frederick L Grover; John E Mayer; Sean M O'Brien; Elizabeth DeLong; Eric D Peterson; Charles McKay; Richard E Shaw; Kirk N Garratt; George D Dangas; John Messenger; Lloyd W Klein; Jeffrey J Popma; William S Weintraub Journal: Ann Thorac Surg Date: 2014-04-26 Impact factor: 4.330
Authors: Connie N Hess; Sunil V Rao; David Dai; Megan L Neely; Robert N Piana; John C Messenger; Eric D Peterson Journal: Am Heart J Date: 2014-01-04 Impact factor: 4.749