Comparison of coronary artery stenting outcomes in the eras before and after the introduction of drug-eluting stents

Edward L. Hannan, Michael Racz, David Holmes, Gary Walford, Samin Sharma, Stanley Katz, Robert H. Jones, Spencer B. King

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

BACKGROUND - Few studies have compared medium-term outcomes for drug-eluting stents (DES) and bare metal stents, and most are relatively small randomized controlled trials. Furthermore, since the introduction of DES, there has been increased use and duration of use of clopidogrel, statins, and other evidence-based therapies. The purpose of the present study was to compare outcomes for patients who underwent stenting in the eras before and after the introduction of DES. METHODS AND RESULTS - New York state patients undergoing stenting in all nonfederal hospitals in the state were studied. Patients were excluded if they had a previous revascularization. Risk factors that were significant predictors of adverse outcomes were used to adjust adverse outcome rates. The study included 11 436 patients who received stents between October 1, 2002, and March 31, 2003, and 12 926 patients who underwent stenting between October 1, 2003, and March 31, 2004. Death rates, the combined end point of death and myocardial infarction (MI), nonfatal MI requiring readmission, target vessel revascularization, and target lesion revascularization were compared at 2 years. Patients in the DES era had significantly better risk-adjusted outcomes for death/MI (adjusted hazard ratio, 0.90; 95% confidence interval, 0.83 to 0.97), 9.9% versus 10.8%; nonfatal MI requiring readmission (adjusted hazard ratio, 0.86; 95% confidence interval, 0.76 to 0.97); target vessel revascularization (adjusted hazard ratio, 0.60; 95% confidence interval, 0.56 to 0.64), 11.2% versus 17.9%; and target lesion revascularization (hazard ratio, 0.55; 95% confidence interval, 0.51 to 0.59), 8.4% versus 14.7%. CONCLUSIONS - Patients in the DES era experienced lower rates of death/MI, nonfatal MI, target vessel revascularization, and target lesion revascularization, but there were no differences in the rates of death. These improvements are likely a result of increased use of clopidogrel, statins, and dual antiplatelet therapy, in addition to the introduction of DES.

Original languageEnglish (US)
Pages (from-to)2071-2078
Number of pages8
JournalCirculation
Volume117
Issue number16
DOIs
StatePublished - Apr 1 2008

Fingerprint

Drug-Eluting Stents
Coronary Vessels
clopidogrel
Myocardial Infarction
Confidence Intervals
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Stents
Mortality
State Hospitals
Randomized Controlled Trials
Metals
Therapeutics

Keywords

  • Bare metal stents
  • Drug-eluting stents
  • Mortality
  • Myocardial infarction
  • Stents

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Comparison of coronary artery stenting outcomes in the eras before and after the introduction of drug-eluting stents. / Hannan, Edward L.; Racz, Michael; Holmes, David; Walford, Gary; Sharma, Samin; Katz, Stanley; Jones, Robert H.; King, Spencer B.

In: Circulation, Vol. 117, No. 16, 01.04.2008, p. 2071-2078.

Research output: Contribution to journalArticle

Hannan, Edward L. ; Racz, Michael ; Holmes, David ; Walford, Gary ; Sharma, Samin ; Katz, Stanley ; Jones, Robert H. ; King, Spencer B. / Comparison of coronary artery stenting outcomes in the eras before and after the introduction of drug-eluting stents. In: Circulation. 2008 ; Vol. 117, No. 16. pp. 2071-2078.
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abstract = "BACKGROUND - Few studies have compared medium-term outcomes for drug-eluting stents (DES) and bare metal stents, and most are relatively small randomized controlled trials. Furthermore, since the introduction of DES, there has been increased use and duration of use of clopidogrel, statins, and other evidence-based therapies. The purpose of the present study was to compare outcomes for patients who underwent stenting in the eras before and after the introduction of DES. METHODS AND RESULTS - New York state patients undergoing stenting in all nonfederal hospitals in the state were studied. Patients were excluded if they had a previous revascularization. Risk factors that were significant predictors of adverse outcomes were used to adjust adverse outcome rates. The study included 11 436 patients who received stents between October 1, 2002, and March 31, 2003, and 12 926 patients who underwent stenting between October 1, 2003, and March 31, 2004. Death rates, the combined end point of death and myocardial infarction (MI), nonfatal MI requiring readmission, target vessel revascularization, and target lesion revascularization were compared at 2 years. Patients in the DES era had significantly better risk-adjusted outcomes for death/MI (adjusted hazard ratio, 0.90; 95{\%} confidence interval, 0.83 to 0.97), 9.9{\%} versus 10.8{\%}; nonfatal MI requiring readmission (adjusted hazard ratio, 0.86; 95{\%} confidence interval, 0.76 to 0.97); target vessel revascularization (adjusted hazard ratio, 0.60; 95{\%} confidence interval, 0.56 to 0.64), 11.2{\%} versus 17.9{\%}; and target lesion revascularization (hazard ratio, 0.55; 95{\%} confidence interval, 0.51 to 0.59), 8.4{\%} versus 14.7{\%}. CONCLUSIONS - Patients in the DES era experienced lower rates of death/MI, nonfatal MI, target vessel revascularization, and target lesion revascularization, but there were no differences in the rates of death. These improvements are likely a result of increased use of clopidogrel, statins, and dual antiplatelet therapy, in addition to the introduction of DES.",
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T1 - Comparison of coronary artery stenting outcomes in the eras before and after the introduction of drug-eluting stents

AU - Hannan, Edward L.

AU - Racz, Michael

AU - Holmes, David

AU - Walford, Gary

AU - Sharma, Samin

AU - Katz, Stanley

AU - Jones, Robert H.

AU - King, Spencer B.

PY - 2008/4/1

Y1 - 2008/4/1

N2 - BACKGROUND - Few studies have compared medium-term outcomes for drug-eluting stents (DES) and bare metal stents, and most are relatively small randomized controlled trials. Furthermore, since the introduction of DES, there has been increased use and duration of use of clopidogrel, statins, and other evidence-based therapies. The purpose of the present study was to compare outcomes for patients who underwent stenting in the eras before and after the introduction of DES. METHODS AND RESULTS - New York state patients undergoing stenting in all nonfederal hospitals in the state were studied. Patients were excluded if they had a previous revascularization. Risk factors that were significant predictors of adverse outcomes were used to adjust adverse outcome rates. The study included 11 436 patients who received stents between October 1, 2002, and March 31, 2003, and 12 926 patients who underwent stenting between October 1, 2003, and March 31, 2004. Death rates, the combined end point of death and myocardial infarction (MI), nonfatal MI requiring readmission, target vessel revascularization, and target lesion revascularization were compared at 2 years. Patients in the DES era had significantly better risk-adjusted outcomes for death/MI (adjusted hazard ratio, 0.90; 95% confidence interval, 0.83 to 0.97), 9.9% versus 10.8%; nonfatal MI requiring readmission (adjusted hazard ratio, 0.86; 95% confidence interval, 0.76 to 0.97); target vessel revascularization (adjusted hazard ratio, 0.60; 95% confidence interval, 0.56 to 0.64), 11.2% versus 17.9%; and target lesion revascularization (hazard ratio, 0.55; 95% confidence interval, 0.51 to 0.59), 8.4% versus 14.7%. CONCLUSIONS - Patients in the DES era experienced lower rates of death/MI, nonfatal MI, target vessel revascularization, and target lesion revascularization, but there were no differences in the rates of death. These improvements are likely a result of increased use of clopidogrel, statins, and dual antiplatelet therapy, in addition to the introduction of DES.

AB - BACKGROUND - Few studies have compared medium-term outcomes for drug-eluting stents (DES) and bare metal stents, and most are relatively small randomized controlled trials. Furthermore, since the introduction of DES, there has been increased use and duration of use of clopidogrel, statins, and other evidence-based therapies. The purpose of the present study was to compare outcomes for patients who underwent stenting in the eras before and after the introduction of DES. METHODS AND RESULTS - New York state patients undergoing stenting in all nonfederal hospitals in the state were studied. Patients were excluded if they had a previous revascularization. Risk factors that were significant predictors of adverse outcomes were used to adjust adverse outcome rates. The study included 11 436 patients who received stents between October 1, 2002, and March 31, 2003, and 12 926 patients who underwent stenting between October 1, 2003, and March 31, 2004. Death rates, the combined end point of death and myocardial infarction (MI), nonfatal MI requiring readmission, target vessel revascularization, and target lesion revascularization were compared at 2 years. Patients in the DES era had significantly better risk-adjusted outcomes for death/MI (adjusted hazard ratio, 0.90; 95% confidence interval, 0.83 to 0.97), 9.9% versus 10.8%; nonfatal MI requiring readmission (adjusted hazard ratio, 0.86; 95% confidence interval, 0.76 to 0.97); target vessel revascularization (adjusted hazard ratio, 0.60; 95% confidence interval, 0.56 to 0.64), 11.2% versus 17.9%; and target lesion revascularization (hazard ratio, 0.55; 95% confidence interval, 0.51 to 0.59), 8.4% versus 14.7%. CONCLUSIONS - Patients in the DES era experienced lower rates of death/MI, nonfatal MI, target vessel revascularization, and target lesion revascularization, but there were no differences in the rates of death. These improvements are likely a result of increased use of clopidogrel, statins, and dual antiplatelet therapy, in addition to the introduction of DES.

KW - Bare metal stents

KW - Drug-eluting stents

KW - Mortality

KW - Myocardial infarction

KW - Stents

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