Home > Interventional Cardiology, Journal Club, Stent thrombosis > Journal Club 21 March 2012

Journal Club 21 March 2012


Article:


Lower risk of stent thrombosis and restenosis with unrestricted use of ‘new-generation’ drug-eluting stents: a report from the nationwide Swedish Coronary Angiography and Angioplasty Registry (SCAAR)

Presenter

LAM

PICO

Population:

SCAAR: Scandinavian registry of percutaneous coronary intervention.

Intervention

Comparator

Outcome

Survival analysis (Cox proportional hazards) for restenosis, stent thrombosis (ARC definition), mortality for bare metal stents, ‘old’ drug eluting stents (includes Endeavor) and ‘new’ drug eluting stents (24 months).

Findings

Discussion Summary 

  • The limitations of registry data were discussed, even with adjustment for important covariates.
  • The prevalence of bare metal stent use was higher than local practice.
  • The low rate of adverse events for new drug eluting stents in the diverse context of a registry was reassuring from a pragmatic viewpoint.
  • The lower mortality rate for drug eluting stents is hypothesis generating. Confounders such as higher prevalence of nare metal stent use in ST elevation myocardial infarction were raised.
  • Another important limitations: no data regarding the duration of dual antiplatelet therapy; reasons for use of stent types; management of restenosis
  • Modelling to determine ‘optimal’ rate of drug eluting stent use based on efficacy data from the randomized clinical trials using cost effectiveness considerations was thought to be valuable. Data from the Melbourne Interventional Group suggested high drug eluting stent use than the the Scandinavian registry and found no difference in clinical outcomes between DES and BMS. The ambiguity of interpretation of this finding was discussed.

The supplementary information is available here. See also the previous post regarding insights from a US registry.

Update 26 March 2012

A meta-analysis comparing everolimus eluting stent with bare metal stent and other drug eluting stents was published in the Lancet. The editorial is available here. Excerpts from the meta-analysis are presented below:


 

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  1. March 28, 2012 at 1:39 pm

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