NEJM: DES reduces mortality, revascularization, based on 2-year data

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In patients presenting with acute MI, treatment with drug-eluting stents (DES) is associated with decreased two-year mortality rates and a reduction in the need for repeat revascularization procedures as compared with treatment with bare-metal stents (BMS), according to a registry published in the Sept. 25 issue of the New England Journal of Medicine.

Studies comparing PCI with drug-eluting and bare-metal coronary stents in acute MI have been limited in size and duration, according to the authors.

Laura Mauri, MD, MSc, from Brigham and Women's Hospital and Harvard Medical School in Boston, and colleagues identified all adults undergoing PCI with stenting for acute MI between April 1, 2003, and September 30, 2004, at any acute care, nonfederal hospital in Massachusetts with the use of a state-mandated database of PCI procedures.

The researchers performed propensity-score matching on three groups of patients: all patients with acute MI, all those with acute MI with ST-segment elevation and all those with acute MI without ST-segment elevation. They based their propensity-score analyses on clinical, procedural, hospital and insurance information collected at the time of the index procedure. Differences in the risk of death between patients receiving DES and those receiving BMS were determined from vital-statistics records.

Mauri and colleagues found that a total of 7,217 patients were treated for acute MI (4,016 with DES and 3201 with BMS). According to analysis of matched pairs, the two-year, risk-adjusted mortality rates were lower for DES than for BMS among all patients with MI (10.7 vs. 12.8 percent), among patients with MI with ST-segment elevation (8.5 vs. 11.6 percent), and among patients with MI without ST-segment elevation (12.8 vs. 15.6 percent).

The two-year, risk-adjusted rates of recurrent MI were reduced in patients with MI without ST-segment elevation who were treated with DES, and repeat revascularization rates were significantly reduced with the use of DES as compared with bare-metal stents in all groups, according to the investigators.

The current results concur with the earlier results from the MASS Registry presented at the 2007 the American Heart Association’s scientific sessions held in Orlando, Fla.