DEScover Registry: DES Outperformed Bare Metal Stents
There were no significant differences in outcomes between sirolimus-eluting stents and paclitaxel-eluting stents.
One-year data from the DEScover registry showed that drug-eluting stents performed better than bare-metal stents at reducing the rates of death, myocardial infarction (MI) and bypass surgery.
“There were significant differences in outcomes in the bare-metal and drug-eluting stent groups at one year,” said lead researcher David O. Williams, MD, of Rhode Island Hospital in Providence.
“The rate of death was higher in the bare-metal stent group at 5.9%, compared with 3.1% of patients receiving drug-eluting stents; rates of MI trended higher in bare-metal stent patients.
Repeat revascularization was less common in drug-eluting stent patients at 6% compared with bare-metal stent patients at 9.5%.”
Investigators also compared outcomes in patients receiving a paclitaxel- vs. a sirolimus-eluting stent.
“There were no clear-cut outcome differences between sirolimus-eluting stents and paclitaxel-eluting stents at one year,” said discussant Michael J. Cowley, MD, Professor of Medicine at Medical College of Virginia Hospital, Virginia Commonwealth University Health System.
Registry specifics
The DEScover registry included 7,752 patients who received one or more stents or balloon angioplasty. Data were collected from 140 U.S. centers that represented a large, cross-sectional experience of percutaneous coronary intervention (PCI), according to co-researcher J. Dawn Abbott, MD, Assistant Professor of Medicine at Rhode Island Hospital.
Ninety-six percent of patients received one or more stents, compared with 4% of patients (n = 325) who were treated with balloon angioplasty. Of those who received a stent, 5% of patients (n = 397) received a bare-metal stent and 95% (n = 7,023) received a drug-eluting stent.
Of those, 55% (n = 3,873) received a sirolimus-eluting stent; 38% (n = 2,636) received a paclitaxel-eluting stent; 7% (n = 514) received a combination of the two.
Cowley said that physicians predominantly chose bare-metal stents for patients with acute MI (32% vs. 21%) and prior coronary artery bypass graft. In contrast, drug-eluting stents were preferred in patients with prior stent procedures.
Limitations
The registry data had some limitations, according to Cowley. As an observational study, there was no randomized group for true comparison. Event reporting was site-determined, and there was no central core lab for endpoint analysis.
The centers involved may not have been representative of the entire population, with 84% of all sites based in either the eastern or central portions of the country. Additionally, one-year follow-up included data on only 89.6% of the study population.