TY - JOUR
T1 - Long-Term Impact of Drug-Eluting Stents Versus Bare-Metal Stents on All-Cause Mortality
AU - Shishehbor, Mehdi H.
AU - Goel, Sachin S.
AU - Kapadia, Samir R.
AU - Bhatt, Deepak L.
AU - Kelly, Peter
AU - Raymond, Russell E.
AU - Galla, John M.
AU - Brener, Sorin J.
AU - Whitlow, Patrick L.
AU - Ellis, Stephen G.
N1 - Funding Information:
Dr. Shishehbor is supported, in part, by Case Western Reserve University/Cleveland Clinic CTSA (1KL2RR024990). Dr. Bhatt has received research grants (directly to the institution) from Bristol-Myers Squibb, Eisai, Ethicon, Heartscape, Sanofi-Aventis, The Medicines Company; honoraria (donated to nonprofits for >2 years): AstraZeneca, Bristol-Myers Squibb, Centocor, Daiichi-Sankyo, Eisai, Eli Lilly, GlaxoSmithKline, Millennium, Paringenix, PDL, Sanofi-Aventis, Schering-Plough, The Medicines Company, tns Healthcare; Speakers' Bureau (>2 years ago): Bristol-Myers Squibb, Sanofi-Aventis, The Medicines Company; consultant/advisory board (any honoraria donated to nonprofits): Astellas, AstraZeneca, Bristol-Myers Squibb, Cardax, Centocor, Cogentus, Daiichi-Sankyo, Eisai, Eli Lilly, GlaxoSmithKline, Johnson & Johnson, McNeil, Medtronic, Millennium, Molecular Insights, Otsuka, Paringenix, PDL, Philips, Portola, Sanofi-Aventis, Schering-Plough, Scios, The Medicines Company, tns Healthcare, Vertex; expert testimony regarding clopidogrel (the compensation was donated to a nonprofit organization); Cleveland Clinic Coordinating Center currently receives or has received research funding from: Abraxis, Alexion Pharma, AstraZeneca, Atherogenics, Aventis, Biosense Webster, Biosite, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, Cardionet, Centocor, Converge Medical Inc., Cordis, Dr. Reddy's, Edwards Lifesciences, Esperion, GE Medical, Genentech, Gilford, GlaxoSmithKline, Guidant, Johnson & Johnson, Kensey-Nash, Eli Lilly, Medtronic, Merck, Mytogen, Novartis, Novo Nordisk, Orphan Therapeutics, Procter & Gamble Pharma, Pfizer, Roche, Sankyo, Sanofi-Aventis, Schering-Plough, Scios, St. Jude Medical, Takeda, The Medicines Company, VasoGenix, and Viacor. Dr. Whitlow has received research grant support from Abbott Vascular, Boston Scientific, and Evalve Inc. and has received consulting fees from Medlogics and Icon International Systems Inc. Dr. Ellis has received consulting fees from Boston Scientific, Cordis, and Abbott Vascular.
PY - 2008/9/23
Y1 - 2008/9/23
N2 - Objectives: Our purpose was to examine the incidence of all-cause mortality among drug-eluting stents (DES) and bare-metal stents (BMS) while adjusting for many confounding factors generally not considered in prior studies. Background: DES use in the U.S. declined by up to 50% in recent years, primarily due to concerns about late stent thrombosis and possibly increased mortality. However, recent data suggest that DES are as safe as BMS and may actually be associated with a lower incidence of myocardial infarction and mortality. Methods: All patients undergoing percutaneous coronary intervention with a DES or BMS alone from March 1, 2003, to June 30, 2007, at a tertiary care center were assessed. Multivariable Cox proportional hazards modeling was performed for overall and propensity-matched patients. Socioeconomic status was calculated using U.S. Census 2000 data. The primary end point was all-cause mortality. Results: There were a total of 832 deaths over a 4.5-year interval among 8,032 patients. Of these, 6,053 received a DES and 1,983 patients had a BMS. All-cause mortality was significantly lower in unadjusted and adjusted Cox proportional models with DES (hazard ratio: 0.62, 95% confidence interval: 0.53 to 0.73; p < 0.001). Similarly, in the propensity-matched group, DES remained associated with lower mortality compared with BMS (adjusted hazard ratio: 0.54, 95% confidence interval: 0.45 to 0.66; p < 0.001). Conclusions: DES were associated with lower mortality in this "real-world" setting. However, despite multiple adjustments, potential confounding may still play a role.
AB - Objectives: Our purpose was to examine the incidence of all-cause mortality among drug-eluting stents (DES) and bare-metal stents (BMS) while adjusting for many confounding factors generally not considered in prior studies. Background: DES use in the U.S. declined by up to 50% in recent years, primarily due to concerns about late stent thrombosis and possibly increased mortality. However, recent data suggest that DES are as safe as BMS and may actually be associated with a lower incidence of myocardial infarction and mortality. Methods: All patients undergoing percutaneous coronary intervention with a DES or BMS alone from March 1, 2003, to June 30, 2007, at a tertiary care center were assessed. Multivariable Cox proportional hazards modeling was performed for overall and propensity-matched patients. Socioeconomic status was calculated using U.S. Census 2000 data. The primary end point was all-cause mortality. Results: There were a total of 832 deaths over a 4.5-year interval among 8,032 patients. Of these, 6,053 received a DES and 1,983 patients had a BMS. All-cause mortality was significantly lower in unadjusted and adjusted Cox proportional models with DES (hazard ratio: 0.62, 95% confidence interval: 0.53 to 0.73; p < 0.001). Similarly, in the propensity-matched group, DES remained associated with lower mortality compared with BMS (adjusted hazard ratio: 0.54, 95% confidence interval: 0.45 to 0.66; p < 0.001). Conclusions: DES were associated with lower mortality in this "real-world" setting. However, despite multiple adjustments, potential confounding may still play a role.
KW - all-cause mortality
KW - bare-metal stents
KW - drug-eluting stents
KW - propensity
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U2 - 10.1016/j.jacc.2008.06.030
DO - 10.1016/j.jacc.2008.06.030
M3 - Article
C2 - 18848135
AN - SCOPUS:51449108158
SN - 0735-1097
VL - 52
SP - 1041
EP - 1048
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 13
ER -