| Outcomes following coronary stenting in the era of bare-metal vs the era of drug-eluting stents. | |
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MedLine Citation:
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PMID: 18577731 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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CONTEXT: Although drug-eluting stents reduce restenosis rates relative to bare-metal stents, concerns have been raised that drug-eluting stents may also be associated with an increased risk of stent thrombosis. Our study focused on the effect of stent type on population-based interventional outcomes. OBJECTIVE: To compare outcomes of Medicare beneficiaries who underwent nonemergent coronary stenting before and after the availability of drug-eluting stents. DESIGN, SETTING, AND PATIENTS: Observational study of 38,917 Medicare patients who underwent nonemergent coronary stenting from October 2002 through March 2003 when only bare-metal stents were available (bare-metal stent era cohort) and 28,086 similar patients who underwent coronary stenting from September through December 2003, when 61.5% of patients received a drug-eluting stent and 38.5% received a bare-metal stent (drug-eluting stent era cohort). Follow-up data were available through December 31, 2005. MAIN OUTCOME MEASURES: Coronary revascularization (percutaneous coronary intervention, coronary artery bypass surgery), ST-elevation myocardial infarction, survival through 2 years of follow-up. RESULTS: Relative to the bare-metal stent era, patients treated in the drug-eluting stent era had lower 2-year risks for repeat percutaneous coronary interventions (17.1% vs 20.0%, P < .001) and coronary artery bypass surgery (2.7% vs 4.2%, P < .01). The difference in need for repeat revascularization procedures between these 2 eras remained significant after risk adjustment (hazard ratio, 0.82; 95% confidence interval, 0.79-0.85). There was no difference in unadjusted mortality risks at 2 years (8.4% vs 8.4%, P =.98 ), but a small decrease in ST-elevation myocardial infarction existed (2.4% vs 2.0%, P < .001). The adjusted hazard of death or ST-elevation myocardial infarction at 2 years was similar (hazard ratio, 0.96; 95% confidence interval, 0.92-1.01). CONCLUSION: The widespread adoption of drug-eluting stents into routine practice was associated with a decline in the need for repeat revascularization procedures and had similar 2-year risks for death or ST-elevation myocardial infarction to bare-metal stents. |
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Authors:
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David J Malenka; Aaron V Kaplan; F Lee Lucas; Sandra M Sharp; Jonathan S Skinner |
Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: JAMA : the journal of the American Medical Association Volume: 299 ISSN: 1538-3598 ISO Abbreviation: JAMA Publication Date: 2008 Jun |
Date Detail:
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Created Date: 2008-06-25 Completed Date: 2008-06-30 Revised Date: 2013-04-24 |
Medline Journal Info:
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Nlm Unique ID: 7501160 Medline TA: JAMA Country: United States |
Other Details:
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Languages: eng Pagination: 2868-76 Citation Subset: AIM; IM |
Affiliation:
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Section of Cardiology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA. david.malenka@hitchcock.org |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Angioplasty, Balloon, Coronary Cohort Studies Coronary Artery Bypass Coronary Restenosis / epidemiology*, prevention & control* Coronary Stenosis / therapy* Drug-Eluting Stents* / adverse effects Female Humans Male Medicare Myocardial Infarction / epidemiology Myocardial Revascularization* Proportional Hazards Models Risk Stents* Survival Analysis Thrombosis / etiology Treatment Outcome United States |
| Grant Support | |
ID/Acronym/Agency:
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P01 AG019783/AG/NIA NIH HHS; P01 AG019783/AG/NIA NIH HHS; P01 AG019783-08/AG/NIA NIH HHS |
| Comments/Corrections | |
Comment In:
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JAMA. 2009 Jan 7;301(1):33; author reply 34
[PMID:
19126807
]
JAMA. 2009 Jan 7;301(1):33-4; author reply 34 [PMID: 19126806 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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