Journal of Invasive Cardiology

Despite a finding of lower rates of adverse cardiac events than in bare-metal stent patients, cardiac mortality was significantly higher in patients who received drug-eluting stents

ACC 2010, Atlanta, Georgia – More research is needed on the relative costs and benefits of using drug-eluting versus bare-metal stents in patients who have experienced a ST-elevation myocardial infarction (heart attack), according to research presented today at the American College of Cardiology’s 59th annual scientific session. ACC.10 is the premier cardiovascular medical meeting, bringing together cardiologists and cardiovascular specialists to further advances in cardiovascular medicine.

Bare-metal stents, small mesh tubes used to prop open damaged arteries, have been a common treatment of coronary artery disease for almost two decades. More recently, drug-eluting stents, which slowly release anti-clotting drugs in addition to physically propping open the artery, have been shown to be effective and efficient in the treatment of coronary artery disease. However, there have been limited clinical trials exploring the long-term effects of drug-eluting stents in patients that had experienced a ST-Elevation Myocardial Infarction (STEMI).

A team of Danish researchers recently completed a three-year trial examining the effectiveness and risks of drug-eluting stents versus bare-metal stents. The team randomly assigned 626 patients who received percutaneous coronary intervention (PCI), also known as coronary angioplasty, within 12 hours of a STEMI to receive either a drug-eluting stent or a bare-metal stent. After three years, patients who had received a bare-metal stent were more likely to have experienced a variety of negative outcomes including target lesion revascularization, target vessel revascularization, and other major adverse cardiac events. All-cause mortality, the rates of a heart attack, re-infarction and stroke were similar in both groups. However, patients in the drug-eluting stents group were more likely to die from cardiac-related problems.

“The key message here,” said Peter Clemmensen, M.D., of Copenhagen University Hospital, Denmark, and President of the Danish Heart Foundation, “is that we have shown that, despite a finding of lower major adverse cardiac events, cardiac mortality was significantly higher in the drug-eluting stent group.”

Because of this mixed set of results, further study is warranted to determine the long-term effects of drug-eluting versus bare-metal stents.

“We encourage other trialists to conduct long-term follow up in their STEMI trials involving drug-eluting stents,” Clemmensen said.

This study received unrestricted grants from Johnson & Johnson, Medtronic, Abbott, and Boston Scientific.