{"id":28489,"date":"2012-04-24T06:19:06","date_gmt":"2012-04-24T10:19:06","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=news&#038;p=28489"},"modified":"2012-04-24T10:09:07","modified_gmt":"2012-04-24T14:09:07","slug":"meta-analysis-compares-drug-eluting-and-bare-metal-stents-for-primary-angioplasty","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2012\/04\/24\/meta-analysis-compares-drug-eluting-and-bare-metal-stents-for-primary-angioplasty\/","title":{"rendered":"Meta-Analysis Compares Drug-Eluting and Bare-Metal Stents for Primary Angioplasty"},"content":{"rendered":"<p>A new meta-analysis\u00a0comparing drug-eluting stents (DES) and bare-metal stents (BMS) in patients with MI has provoked opposing take-away messages from the study authors and an editorialist. The authors emphasize the reduction in target-vessel revascularization (TVR) associated with DES, but the editorialist focuses on several potential DES weaknesses suggested by the study.<\/p>\n<p><a href=\"http:\/\/archinte.ama-assn.org\/cgi\/content\/abstract\/172\/8\/611\">In the paper, published in the <em>Archives of Internal Medicine<\/em><\/a>, members of the Drug-Eluting Stent in Primary Angioplasty (DESERT) Cooperation\u00a0pooled patient data from 11 clinical trials in which nearly 6300 patients were randomized to either sirolimus-eluting or paclitaxel-eluting stents or BMS. \u00a0After a mean follow-up of 1201 days, DES was associated with a significant reduction in TVR but there were no significant differences in death, reinfarction, or stent thrombosis:<\/p>\n<ul>\n<li>TVR: 12.7% for DES vs. 20.1% for BMS, HR 0.57, CI 0.50-0.66, p&lt;0.001<\/li>\n<li>Mortality:\u00a08.5% vs. 10.2%, HR 0.85, CI 0.70- 1.04, p = 0.11<\/li>\n<li>Reinfarction:\u00a09.4% vs. 5.9%, HR 1.12, CI 0.88-1.41, p = 0.36<\/li>\n<li>Stent thrombosis:\u00a05.8% vs. 4.3%, HR 1.13, CI 0.86-1.47, p = 0.38<\/li>\n<\/ul>\n<p>However, after 2 years there was a significant increase in the risk of stent thrombosis associated with the DES group (HR 2.81, CI 1.28-6.19, p=0.04).<\/p>\n<p>The findings, write the authors,<\/p>\n<blockquote><p>provide strong evidence of the beneficial effects of SES and PES during primary PCI in STEMI. With follow-up as late as 6 years, a robust and sustained decrease in TVR was noted with use of these DES. Although the rates of late reinfarction and ST progressively increased, with the difference becoming statistically significant after 2 years in patients receiving SES and PES, the HR for mortality, while not significantly different between DES and BMS, favored DES.<\/p><\/blockquote>\n<p>In\u00a0<a href=\"http:\/\/archinte.ama-assn.org\/cgi\/content\/extract\/172\/8\/621\">an accompanying editorial<\/a>, James Brophy notes that the difference in TVR \u201cmay be artificially inflated by protocol-mandated, rather than clinically driven, repeated angiograms.\u201d Brophy \u00a0also states that analyzing the data with a different statistical approach leaves open the possibility that DES is associated with a twofold increase in the risk of reinfarction. Brophy provides the follow perspective on choosing BMS versus DES for MI patients:<\/p>\n<blockquote><p>An informed patient with STEMI should be told that substituting DES for BMS in 100 patients likely results in no mortality differences but approximately 5 fewer repeat revascularizations at the cost of 1 additional late reinfarction with a possibility that this risk may be substantially higher.<\/p><\/blockquote>\n<p><em><a title=\"Primary PCI Meta-Analysis: Mortality Trumps All\" href=\"http:\/\/blogs.nejm.org\/cardioexchange\/interventional\/primary-pci-meta-analysis-mortality-trumps-all\/\">Click here to read a response to the editorial by DESERT senior author Gregg Stone.<\/a> Comments on this topic should also be posted here.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A new meta-analysis\u00a0comparing drug-eluting stents (DES) and bare-metal stents (BMS) in patients with MI has provoked opposing take-away messages from the study authors and an editorialist. The authors emphasize the reduction in target-vessel revascularization (TVR) associated with DES, but the editorialist focuses on several potential DES weaknesses suggested by the study. In the paper, published [&hellip;]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9],"tags":[945,821,301,302,437],"class_list":["post-28489","post","type-post","status-publish","format-standard","hentry","category-interventional-cardiology","tag-bare-metal-stents","tag-drug-eluting-stents","tag-pci","tag-primary-pci","tag-stents"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/28489","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=28489"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/28489\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=28489"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=28489"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=28489"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}