The widespread adoption of drug-eluting stents during percutaneous coronary interventions has decreased the incidence of repeat revascularization procedures without increasing mortality rates, according to new research.

The widespread adoption of drug-eluting stents during percutaneous coronary interventions (PCI) has decreased the incidence of repeat revascularization procedures without increasing mortality rates, according to new research.

"Although other data may suggest some incremental risk of stent thrombosis with the use of drug-eluting stents, we can detect no adverse consequence to the health of the population," Dr. David J. Malenka and colleagues report in the June 25 issue of the Journal of the American Medical Association.

Dr. Malenka, at the Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, and associates compared outcomes among Medicare beneficiaries age 65 years and older who underwent a first non-emergent revascularization with coronary stenting before and after the availability of drug-eluting stents.

Their observational study included 38,917 patients treated from October 2002 through March 2003 immediately before the introduction of the first drug-eluting stent, and 28,086 similar patients treated from September through December 2003. During the latter period, 61.5 per cent of patients received a sirolimus-eluting stent; the remaining 38.5 per cent of patients were given a bare-metal stent.

Relative to the bare-metal stent era, patients treated after drug-eluting stents became available had lower two-year risks for repeat PCI (17.1 vs 20.0 per cent, p < 0.001) and coronary artery bypass surgery (2.7 per cent vs 4.2 per cent, p < 0.01).

After adjustment for demographics and comorbidity, treatment during the drug-eluting stent era was associated with a significantly lower cumulative hazard of repeat revascularization at two years (adjusted hazard ratio 0.82).

There was no significant difference between treatment periods in the adjusted hazard ratio of death or ST-elevation MI, the report indicates. Results were similar for subgroups based on gender, age, ethnicity, and presence of diabetes.