[TCT2007]DES Efficacy Expands Beyond Current Labeling

Drug-eluting stents reduced TVR without a detrimental effect on stent thrombosis.

DES implantation and prolonged dual-antiplatelet therapy in patients who are not indicated for newer stents appears to be superior to bare-metal stents or use of DES and short-duration dualantiplatelet therapy, according to results of the Guthrie PCI registry.

When comparing DES with baremetal stents all-cause mortality was 11.5% for patients treated with baremetal stents vs. 5.2% for patients treated with DES (P = .052). Kishore J. Harjai, MD, a cardiologist at Guthrie Hospital System in Sayre, Pa., said this difference may be exaggerated because follow-up was 800 days for bare-metal stents and 500 days for DES. Other outcomes also favored DES (Table).

 
Patients treated with DES who had antiplatelet therapy for more than 12 months had a 7.6% rate of death or MI. Patients treated with DES and antiplatelet therapy for 12 months or less had an 11% rate of death or MI.

Among patients treated with BMS, the rate of MI or death was 13% if antiplatelet therapy lasted longer than 12 months and 16% if antiplatelet therapy was 12 months or less.

Sicker patients

The Guthrie PCI registry is a single-center, prospective, ongoing observational PCI registry. It began
in July 2001. Guthrie researchers monitor clinical outcomes for all PCIs using medical record review,
telephone questionnaire, and Social Security Death Index.

Researchers had originally screened 3,044 patients between July 2001 and December 2005 but
excluded 409 who did not receive a stent, 443 who had a previous PCI during the study period, 69 who had been given both a DES and a baremetal stent, and a final 769 patients who were not indicated for DES under current labeling.

Harjai said the patients (n=1,354) in the Guthrie registry were sicker than the general PCI population, with
21% having a prior MI and 21% having prior CABG. Nearly half of the patients needed an urgent procedure, and mean LVEF was 45% (Figure).