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Target vessel revascularization rates are lower with drug-eluting stents than with bare metal stents, particularly in patients with multivessel disease, according to an analysis.

In a real-world setting, target vessel revascularization rates are lower with drug-eluting stents (DES) than with bare metal stents (BMS), particularly in patients with multivessel coronary artery disease, according to an analysis of the Duke Databank for Cardiovascular Disease.

Dr. Kevin J. Anstrom and colleagues at Duke University in Durham, North Carolina, point out in the August 11/25 issue of the Archives of Internal Medicine that clinical trials of DES vs BMS involved low-risk patients with single-vessel disease, followed for no more than a year.

To assess outcomes in a clinical practice setting, the researchers analyzed data on 1501 patients who received DES and 3165 who received BMS between January 1, 2000 and July 31, 2005.

They report that "DES reduced target vessel revascularization (TVR) rates at six, 12 and 24 months compared with BMS." The rates at 24 months were 6.6 per cent and 16.3 per cent, respectively.

There was no significant difference between sirolimus-eluting stents and paclitaxel-eluting stents.

The greater the complexity of CAD, the greater the benefit with DES over BMS, Dr. Anstrom and colleagues note. The TVR rate for single-vessel disease was 8.3 per cent lower with DES than BMS. For two-vessel disease, the difference was 9.7 per cent and for three-vessel disease, it was 16.2 per cent.

"Although TVR rates in clinical practice may differ from what is seen in clinical trials, the overall relative benefit appears preserved," co-author Dr. David Kong told Reuters Health.

Nonetheless, bare metal stents will still have a role in clinical practice for several reasons, Dr. Kong pointed out. "First, there will be populations of patients who need stents but are unable to take prolonged dual antiplatelet therapy. Second, there are types of lesions where the anticipated benefit of DES technology is small (as in large vessels with short lesions) due to the already low rate of repeat revascularization. In these situations, BMS may be reasonable."

Furthermore, Dr. Kong added, "In the United States, there are still clinical situations, for example in vessels less than 2.5 mm diameter, for which no DES are currently available."

Arch Intern Med 2008;168:1647-1655