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Clinical outcomes of drug-eluting stents compared with bare metal stents in our routine clinical practice.

INTRODUCTION
This study was designed to characterize patients treated with drug-eluting stents (DES) versus those treated with bare metal stents (BMS) and to investigate their clinical outcomes in our routine clinical practice.


METHODS
We studied a consecutive series of 1796 patients, selected from a computerized registry, who underwent stenting for coronary artery lesions either with BMS (1568 patients, 87.3%) or DES (228 patients, 12.7%) between April 2003 and March 2005. In this study, those with myocardial infarction (MI) within 48 hours preceding the procedure were excluded. Patients with more than one lesion were included only if the lesions were entirely treated either with BMS or DES.


RESULTS
Type B2/C, left anterior descending artery, and diffuse lesions were more frequent in the group treated with DES (p<0.001). There was no difference between these groups in terms of acute success rates, although periprocedural non-Q wave MI occurred more frequently in the DES group (2.7% vs. 0.9%, p=0.03). At 18-month follow up, a univariate analysis showed no difference in the rate of major adverse cardiac events (MACE) with DES (2.2%) vs. BMS (4.2%). However, a multivariate analysis showed DES to independently decrease the risk of this cumulative outcome (hazard ratio=0.36, 95% CI=0.13-0.95) and the single endpoint of target vessel revascularization (hazard ratio=0.25, 95% CI=0.07-0.89). At 12 months, the survival rate in the DES group was higher than that in the BMS group as a trend (p=0.06). At 18 months, the occurrence of late thrombotic events in the DES group reduced this gap (95.7% vs. 94.7%, p=0.1).


CONCLUSIONS
Use of drug-eluting stents in our routine practice was effective in reducing the rate of major adverse cardiac events, when compared with patients treated with bare metal stents at mid-term follow up. For the evaluation of effects of drug-eluting stents in long-term follow up, further studies of larger populations are required.