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. 2010 Jun 15;33(6):E22–E29. doi: 10.1002/clc.20655

Long‐term Clinical Outcomes of Drug‐Eluting Stents Vs Bare‐Metal Stents in Chinese Patients

Hee‐Hwa Ho 1,2, Vincent Pong 1,2, Chung‐Wah Siu 1,2,3, Man‐Hong Jim 2, Raymond Miu 1,3, Kai‐Hang Yiu 1,3, Ryan Ko 1,3, Hung‐Fat Tse 1,3, On‐Hing Kwok 2, Wing‐Hing Chow 2,✉
PMCID: PMC6652983  PMID: 20556818

Abstract

Background

There is limited data on the magnitude of the problem of drug‐eluting stent (DES) thrombosis in the Asian population.

Hypothesis

We evaluated the long‐term clinical outcomes of DES vs bare metal stents (BMS) in Chinese patients.

Methods

From January 2002 to October 2005, 1236 consecutive patients underwent percutaneous coronary intervention with DES or BMS coronary stent implantation at our institution. We analyzed major clinical end points like all‐cause mortality, cardiovascular death, myocardial infarction, target lesion revascularization (TLR), and stent thrombosis.

Results

The 3‐year cumulative rates of all‐cause mortality, cardiovascular death, and myocardial infarction were significantly lower in the DES group (3.4%, 0.9%, 3.6%) when compared with the BMS group (7.5%, 4.4%, 6.2%; P < .05). No significant differences were found in the 3‐year cumulative rates for TLR or stent thrombosis when comparing the DES group (8.3%, 1.63%) vs the BMS group (9.6%, 1.6%; P > .05). However, after 1 year, there were 8 episodes of stent thrombosis in the DES group vs 1 episode of stent thrombosis in the BMS group (P = .04).

Conclusion

Drug‐eluting stents are associated with a significant reduction in the 3‐year cumulative rates of all‐cause mortality, cardiovascular death, and myocardial infarction when compared to BMS. However, there were no significant differences in the cumulative rates of TLR or stent thrombosis at 3 years. Stent thrombosis after 1 year was more common in the DES group, but this did not translate to increased mortality. The suggestion that DES might confer a mortality benefit should be interpreted with caution as there could be several confounding factors that were not identified in our study. Copyright © 2010 Wiley Periodicals, Inc.

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References

  • 1. Morice MC, Serruys PW, Sousa JE, et al. A randomised comparison of a sirolimus‐eluting stent with a standard stent for coronary revascularisation. N Engl J Med 2002; 346: 1773–1780. [DOI] [PubMed] [Google Scholar]
  • 2. Moses JW, Leon MB, Popma JJ, et al. Sirolimus‐eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 2003; 349: 1315–1323. [DOI] [PubMed] [Google Scholar]
  • 3. Grube E, Silber S, Hauptmann KE, et al. TAXUS I: six and twelve‐month results from a randomised, double blind trial on a slow release paclitaxel‐eluting stent for de novo coronary lesions. Circulation 2003; 107: 38–42. [DOI] [PubMed] [Google Scholar]
  • 4. Stone GW, Ellis SG, Cox DA, et al. A polymer based paclitaxel‐eluting stent in patients with coronary artery disease. N Engl J Med 2004; 350: 221–231. [DOI] [PubMed] [Google Scholar]
  • 5. Schofer J, Schlüter M, Gershlick AH, et al; E‐SIRIUS Investigators . Sirolimus‐eluting stents for treatment of patients with long atherosclerotic lesions in small coronary arteries: a double‐blind randomised controlled trial (E‐SIRIUS). Lancet 2003; 362: 1093–1099. [DOI] [PubMed] [Google Scholar]
  • 6. Ge L, Iakovou I, Cosgrave J, et al. Immediate and mid‐term outcomes of sirolimus‐eluting stents implantation for chronic total occlusions. Eur Heart J 2005; 26: 1056–1062. [DOI] [PubMed] [Google Scholar]
  • 7. Kastrati A, Mehilli J, von Beckerath N, et al; ISAR‐DESIRE Study Investigators . Sirolimus‐eluting stent of paclitaxel‐eluting stent versus balloon angioplasty for prevention of recurrences in patients with coronary in‐stent restenosis: a randomised controlled trial. JAMA 2005; 293: 165–171. [DOI] [PubMed] [Google Scholar]
  • 8. Ellis SG, Kandzari D, Kereiakes DJ, et al. Utility of sirolimus‐eluting Cypher stents to reduce 12‐month target vessel revascularisation in saphenous vein graft stenoses: results of a multicenter 350‐patient case‐control study. J Invasive Cardiol 2007; 19(10): 404–409. [PubMed] [Google Scholar]
  • 9. Cheiffo A, Stankovic G, Bonizzoni E, et al. Early and mid‐term results of drug‐eluting stent implantation in unprotected left main. Circulation 2005; 111: 791–795. [DOI] [PubMed] [Google Scholar]
  • 10. Lemos PA, Saia F, Hofma SH, et al. Short and long‐term clinical benefit of sirolimus‐eluting stents compared to conventional bare stents for patients in acute myocardial infarction. J Am Coll Cardiol 2004; 43: 704–708. [DOI] [PubMed] [Google Scholar]
  • 11. Daemen J, Wenaweser P, Tsuchida K, et al. Early and late coronary stent thrombosis of sirolimus‐eluting and paclitaxel‐eluting stents in routine clinical practice: data from a large two‐institutional cohort study. Lancet 2007; 369: 667–678. [DOI] [PubMed] [Google Scholar]
  • 12. Camenzind E, Steg PG, Wijns W. Stent thrombosis late after implantation of first generation drug‐eluting stents. A cause of concern. Circulation 2007; 1155: 1440–1455. [DOI] [PubMed] [Google Scholar]
  • 13. Pfisterer M, Brunner‐La Rocca HP, Buser PT, et al; for the BASKET‐LATE Investigators . Late clinical events after clopidogrel discontinuation may limit the benefit of drug‐eluting stents: an observational study of drug‐eluting versus bare metal stents. J Am Coll Cardiol 2006; 48: 2584–2591. [DOI] [PubMed] [Google Scholar]
  • 14. Lagerqvist B, James SK, Stenestrand U, et al. Long term outcomes with drug‐eluting stents versus bare metal stents in Sweden. N Engl J Med 2007; 356: 1009–1019. [DOI] [PubMed] [Google Scholar]
  • 15. Stone GW, Moses JW, Ellis SG, et al. Safety and efficacy of sirolimus and paclitaxel eluting coronary stents. N Engl J Med 2007; 356: 998–1008. [DOI] [PubMed] [Google Scholar]
  • 16. Kastrati A, Mehilli J, Pache J, et al. Analysis of 14 trials comparing sirolimus‐eluting stents with bare metal stents. N Engl J Med 2007; 356: 1030–1039. [DOI] [PubMed] [Google Scholar]
  • 17. Spaulding C, Daemen J, Boersma E, et al. A pooled analysis of data comparing sirolimus‐eluting stents with bare metal stents. N Engl J Med 2007; 356: 989–997. [DOI] [PubMed] [Google Scholar]
  • 18. Stettler C, Wandel S, Allemann S, et al. Outcomes associated with drug‐eluting and bare metal stents: a collaborative network meta‐analysis. Lancet 2007; 370: 937–948. [DOI] [PubMed] [Google Scholar]
  • 19. Mauri L, Hsieh WH, Massaro JM, et al. Stent thrombosis in randomised clinical trials of drug‐eluting stents. N Engl J Med 2007; 356(10): 1020–1029. [DOI] [PubMed] [Google Scholar]
  • 20. Cutlip DE, Windecker S, Mehran R, et al; Academic Research Consortium . Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 2007; 115(17): 2344–2351. [DOI] [PubMed] [Google Scholar]
  • 21. Luscher TF, Steffel J, Eberli FR, et al. Drug‐eluting stent and coronary thrombosis:biological mechanisms and clinical implications. Circulation 2007; 115: 1051–1058. [DOI] [PubMed] [Google Scholar]
  • 22. Joner M, Finn AV, Farb A, et al. Pathology of drug‐eluting stents in humans: delayed healing and late thrombotic risk. J Am Coll Cardiol 2006; 48: 193–202. [DOI] [PubMed] [Google Scholar]
  • 23. Iakovou I, Schmidt T, Bonizzoni E, et al. Incidence, predictors and outcome of thrombosis after successful implantation of drug‐eluting stents. JAMA 2005; 293: 2126–2130. [DOI] [PubMed] [Google Scholar]
  • 24. Virmani R, Guagliumi G, Farb A, et al. Localised hypersensitivity and late coronary thrombosis secondary to a sirolimus‐eluting stent: should we be cautious? Circulation 2004; 109: 701–705. [DOI] [PubMed] [Google Scholar]
  • 25. Eisenstein EL, Anstrom KJ, Kong DF, et al. Clopidogrel use and long term clinical outcomes after drug‐eluting stent implantation. JAMA 2007; 297: 159–168. [DOI] [PubMed] [Google Scholar]
  • 26. Jensen LO, Maeng M, Kaltoft A, et al. Stent thrombosis, myocardial infarction and death after drug‐eluting and bare metal stent coronary interventions. J Am Coll Cardiol 2007; 50: 463–470. [DOI] [PubMed] [Google Scholar]
  • 27. Nordmann AJ, Briell M, Bucher HC. Mortality in randomized controlled trials comparing drug‐eluting verses bare metal stents in coronary artery disease. Eur Heart J 2006; 277: 2784–2814. [DOI] [PubMed] [Google Scholar]
  • 28. Stone GW, Ellis SG, Colombo A, et al. Offsetting impact of thrombosis and restenosis on the occurrence of death and myocardial infarction after paclitaxel‐eluting and bare metal stent implantation. Circulation 2007; 115: 2842–2847. [DOI] [PubMed] [Google Scholar]
  • 29. Serruys PW, de Jaegere P, Kiemeneij F, et al. A comparison of balloon‐expandable‐stent implantation with balloon angioplasty in patients with coronary artery disease. N Engl J Med 1994; 331: 489–495. [DOI] [PubMed] [Google Scholar]
  • 30. Fischman DL, Leon MB, Baim DS, et al. A randomized comparison of coronary‐stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med 1994; 331: 496–501. [DOI] [PubMed] [Google Scholar]
  • 31. Walters DL, Harding SA, Walsh CR, et al. Acute coronary syndrome is a common clinical presentation of in‐stent restenosis. Am J Cardiol 2002; 89: 491–494. [DOI] [PubMed] [Google Scholar]
  • 32. Chen MS, John JM, Chew DP, et al. Bare metal stent restenosis is not a benign clinical entity. Am Heart J 2006; 151: 1260–1264. [DOI] [PubMed] [Google Scholar]

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