Drug-eluting stents associated with reduced 2-year mortality rates among MI patients

Drug-eluting stents (DES) reduce two-year mortality in acute MI patients, as compared to treatment with bare-metal stents, research shows.   Percutaneous coronary intervention (PCI) using stents have been shown to reduce the rate of death among patients with MI, particularly those with ST-segment elevation, compared to medical therapy alone. However, studies comparing bare-metal and drug-eluting stents for MI have been limited in size and duration and observational studies have had conflicting results. The current study sought to determine if there was any harm associated with the use of drug-eluting stents compared with bare-metals stents among patients with MI. The researchers analysed an unselected population-based cohort of patients presenting with MI who were treated with either drug-eluting or bare-metal stents. Since the type of stent used was not randomly assigned, propensity-score matching was used to minimise bias. A total of 7217 patients were treated for acute MI (4016 with drug-eluting stents and 3201 with bare-metal stents). They performed the propensity-score matching on three groups: (all patients with acute MI, all patients with acute MI with ST-segment elevation, and all patients with acute MI without ST-segment elevation). The primary outcome was death from any cause within 2 years of the procedure and the secondary outcome variables included recurrent MI and repeat vascularisation. To determine if the differences in the risk of death between patients receiving drug-eluting and bare-metal stents, vital-statistics records (which included in-hospital mortality information) were used. The results revealed that the 2-year, risk-adjusted mortality rates for drug-eluting stents were lower than that for bare-metal stents among all patients with MI (10.7% versus 12.8%; p=0.02), among patients with MI with ST-segment elevation (8.5% versus 11.6%; p=0.0008), and among patients with MI without ST-segment elevation (12.8% versus 15.6%; p=0.04). In conclusion, the authors found that among patients presenting with acute MI, treatment with drug-eluting stents is associated with decreased 2-year mortality rates and a reduction in the need for repeat revascularisation procedures compared with those treated with bare-metal stents. Reference Mauri, L. Silbaugh, T. 2008, ‘Drug-eluting or bare-metal stents for acute myocardial infarction’New England Journal of Medicine; 359: 1330—1342....