Drug-Eluting or Bare-Metal Stents for Coronary Artery Disease.

BACKGROUND: Limited data are available on the long-term effects of contemporary drug-eluting stents versus contemporary bare-metal stents on rates of death, myocardial infarction, repeat revascularization, and stent thrombosis and on quality of life. METHODS: We randomly assigned 9013 patients who had stable or unstable coronary artery disease to undergo percutaneous coronary intervention (PCI) with the implantation of either contemporary drug-eluting stents or bare-metal stents. In the group receiving drug-eluting stents, 96% of the patients received either everolimus- or zotarolimus-eluting stents. The primary outcome was a composite of death from any cause and nonfatal spontaneous myocardial infarction after a median of 5 years of follow-up. Secondary outcomes included repeat revascularization, stent thrombosis, and quality of life. RESULTS: At 6 years, the rates of the primary outcome were 16.6% in the group receiving drug-eluting stents and 17.1% in the group receiving bare-metal stents (hazard ratio, 0.98; 95% confidence interval [CI], 0.88 to 1.09; P=0.66). There were no significant between-group differences in the components of the primary outcome. The 6-year rates of any repeat revascularization were 16.5% in the group receiving drug-eluting stents and 19.8% in the group receiving bare-metal stents (hazard ratio, 0.76; 95% CI, 0.69 to 0.85; P<0.001); the rates of definite stent thrombosis were 0.8% and 1.2%, respectively (P=0.0498). Quality-of-life measures did not differ significantly between the two groups. CONCLUSIONS: In patients undergoing PCI, there were no significant differences between those receiving drug-eluting stents and those receiving bare-metal stents in the composite outcome of death from any cause and nonfatal spontaneous myocardial infarction. Rates of repeat revascularization were lower in the group receiving drug-eluting stents. (Funded by the Norwegian Research Council and others; NORSTENT ClinicalTrials.gov number, NCT00811772 .).

[Antithrombotic therapy after percutanous coronary intervention with stenting]. / Antitrombotisk behandling etter perkutan koronar intervensjon med stent.

BACKGROUND: Patients with stent thrombosis have a serious prognosis and a high mortality. Insufficient blood platelet inhibition may be the cause of the condition. This article reviews patients--with stents in their coronary arteries--that have had documented effects of long-term blood platelet treatment. MATERIAL AND METHODS: The article is based on literature identified through a Pubmed search and own experience. RESULTS: Premature discontinuation of acetylsalicylic acid and/or clopidogrel, and non-cardiac surgery shortly after stenting are commonly associated with stent thrombosis. Elective non-cardiac surgery should be done without discontinuation of blood platelet inhibitors when possible. It should be delayed for a minimum of 6 weeks after implantation of bare metal stents and for a minimum of 6 months after drug-eluting stents. For patients who need anticoagulation bare metal stents are preferred, and a combination of warfarin, acetylsalicylic acid and clopidogrel should be used as antithrombotic medication. CONCLUSION: It is important to provide adequate information about correct antithrombotic drug use to patients, physicians and pharmacies in order to avoid stent thrombosis and acute myocardial infarction.

Incidence of procedural related myocardial infarction following percutaneous coronary intervention. A matter of definitions.

AIM: To define the incidence of procedural related myocardial infarction (MI) in patients undergoing elective PCI using different definitions of MI, especially focusing on the criteria proposed by the European Society of Cardiology (ESC) and the American College of Cardiology (ACC) for the definition of MI. METHODS AND RESULTS: A prospective study including 220 patients scheduled for elective PCI. To be included, preprocedural values of the following biochemical markers had to be normal; aspartate aminotransferase (AST), creatine kinase (CK) , creatinine kinase MB fraction (mass concentration) (CK-MBmass) and cardiac troponin I (cTnI).According to different definitions the incidence of procedural related MI following PCI differed from 0,9% (previous WHO definition) to 26,4% (ESC/ACC criteria). Other commonly used definitions of MI resulted in incidence rates between these values. CONCLUSIONS: Depending on definitions used the incidence of procedural MI following elective PCI may vary by a factor of 30. This makes comparison of MI rates between institutions difficult. Furthermore, outcome and conclusions in interventional studies with MI as an endpoint may differ according to definitions used for procedural MI. A clear description of the applied definition of procedural MI following PCI is mandatory. For epidemiological and other reasons a separate ICD code is proposed for MIs caused by PCI.