DES no better than BMS in large coronary arteries

21 November 2008

MedWire News: Study findings show no significant differences in major adverse cardiac events (MACE) between patients who receive drug-eluting stents (DES) and those who receive bare-metal stents (BMS) in large coronary vessels.

The researchers suggest that DES may therefore not be cost-effective in large coronary arteries of low-risk patients.

DES have been shown to be superior to BMS in reducing restenosis across a wide range of coronary lesions, but in large vessels the difference in clinical outcomes between BMS and DES is unclear.

David Clark, from Austin Hospital in Heidelberg, Victoria, Australia, and colleagues assessed clinical outcomes 1 year after deployment of BMS compared to DES in patients with large coronary vessels ≥3.5 mm.

Of the 672 patients undergoing percutaneous coronary interventions in 844 lesions, DES was implanted in 39.5% and BMS in 60.5% of lesions. Clinical outcomes monitored included MACE: death, myocardial infarction (MI), and target vessel revascularization (TVR).

In patients who received DES compared with BMS, there was no significant difference in mortality or frequency of MI at 12 months. Rates of TVR were low in both groups at 12 months. The overall MACE rate at 12 months was the same in both groups, at 9.4%.

Writing in the International Journal of Cardiology, the researchers note: “The only multivariate independent predictor of MACE was stent length ≥20 mm (odds ratio=2.07).”

They advise that in “patients who are at low risk for restenosis, such as those with large vessels,” DES should not be routinely used because of evidence of side effects of DES and associated anti-platelet therapy, and on grounds of cost.

They conclude: “Marginal improvement in outcomes from DES use in these low-risk patients with large coronary arteries is unlikely to be cost-effective.”

Int J Cardiol 2008; 130: 374–379