Long-term follow-up finds drug-eluting stents safer, more effective than bare-metal stents

After a median follow-up period of 3.8 years, drug-eluting stents were more effective than bare-metal stents and were associated with fewer instances of stent thrombosis, according to a meta-analysis of 51 randomized, controlled trials.

Tullio Palmerini, MD, of the University of Bologna in Italy, and colleagues also found second-generation drug-eluting stents were superior to first-generation stents for long-term safety and efficacy. Of the second-generation stents, cobalt-chromium everolimus-eluting stents (CoCr-EES) were associated with the lowest rates of long-term adverse events.

They published their findings online in the Journal of the American College of Cardiology on June 8.

The analysis included 52,158 patients who enrolled in randomized, controlled trials that examined FDA-approved drug-eluting stents and bare-metal stents with a follow-up duration of at least three years as well as studies of biolimus-eluting stents (BES). They searched MEDLINE, the Cochrane database, the EMBASE database, the Transcatheter Cardiovascular Therapeutics website, the Clinical Trials website, the Clinical Trial Results website, the American College of Cardiology website and abstracts and presentations from major cardiovascular conferences.

The drug-eluting stents were classified in the following categories: sirolimus-eluting stents (SES), paclitaxel-eluting stents (PES), platinum-chromium EES (PtCr-EES), phosphorylcholine-based zotarolimus-eluting stents (PC-ZES), Resolute ZES (Re-ZES), CoCr-EES and BES.

Palmerini et al found patients who received CoCr-EES had lower rates of mortality, definite stent thrombosis and MI compared with patients who received bare-metal stents, PES and SES. In addition, patients in the PC-ZES group had lower rates of definite stent thrombosis than the SES group and lower rates of MI than the PES and bare-metal stents group.

Further, each of the drug-eluting stents was associated with significantly lower rates of target-vessel revascularization (TVR) than bare-mental stents. CoCr-EES, SES, PtCr-EES and BES were associated with lower rates of TVR than PES, and CoCr-EES had lower rates of TVR than PC-ZES.