Rapid adoption of drug-eluting stents: Clinical practices and outcomes from the early drug-eluting stent era

• Published in: The American heart journal Vol. 160; no. 4; pp. 767 - 774.e1
• Main Authors: Lopez, John J., MD, Keyes, Michelle J., PhD, Nathan, Sandeep, MD, MS, Piana, Robert, MD, Pencina, Michael, PhD, Dhar, Gaurav, MD, Marso, Steven, MD, Rao, Sunil, MD, Shammo, Salim, MD, Marquardt, Walt, MD, Cohen, David J., MD, MSc, Kleiman, Neal S., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.10.2010; Mosby; Elsevier Limited
• Subjects: Acute Coronary Syndrome - epidemiology; Acute Coronary Syndrome - surgery; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Clinical medicine; Coronary Restenosis - epidemiology; Drug therapy; Drug-Eluting Stents; Female; Follow-Up Studies; Heart attacks; Hospital Mortality - trends; Humans; Immunosuppressive Agents - pharmacology; Incidence; Kinases; Male; Medical sciences; Middle Aged; Paclitaxel - pharmacology; Patients; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; Sirolimus - pharmacology; Stents; Thrombosis; Time Factors; Treatment Outcome; United States - epidemiology; Variables; United States; United States > US; Prognosis; Professional practice; Instrumentation therapy; Cardiovascular disease; Early; Circulatory system; Cardiology; Drug eluting stent
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2010.06.048

Objectives We sought to evaluate the early drug-eluting stent (DES) era, characterized by widespread device use. Background Contemporary clinical practice incorporating more selective DES use can only be assessed by understanding the early DES era. Methods All patients receiving DES during the first 3 waves of the Evaluation of Drug Eluting Stents and Ischemic Events (EVENT) Registry (2004-2006) were evaluated. The primary end point was a composite of death, myocardial infarction (MI), and urgent revascularization at discharge and death, MI, or target lesion revascularization (TLR) at 1 year. The composite end point at each time point was compared across waves. Multivariable logistic regression was used for in-hospital outcomes and multivariable Cox regression was used for 1-year end points. Results Ninety-two percent of EVENT patients received at least one DES. One third of patients were treated for Acute Coronary Syndromes (ACS) (33.8%), and later waves included lower lesion complexity. Across waves there was more frequent clopidogrel loading, a decrease in heparin and an increase in bivalirudin use (all P < .01). The primary composite end point of in-hospital death, MI or urgent revascularization occurred in 7.2% of patients, and did not differ across waves. Despite remarkably high levels of routine DES usage, the composite end point of death, MI, or TLR at 1 year averaged 13.5% and did not differ across waves. After adjustment, no statistically significant effect of wave on composite bleeding ( P = .068) as well as in-hospital TLR ( P = .053) was noted. At 1 year, wave was associated with a lower likelihood of TLR in the adjusted model (HR 0.81, P = .03). Conclusions The high-adoption DES era was associated with favorable outcomes, decreasing bleeding rates and changes in antithrombotic approach.