It’s one of those classic battles that exists in every specialty, comparing one method vs. another and every person seems to have a different opinion. For cardiology, drug eluting stents vs. bare metal stents is it, and over the years people have generally begun to settle on using each for different patient groups. What about in a STEMI – which do you choose?
JACC to the rescue, with a 3 year follow up article (based off DEDICATION) with over 600 patients comparing DES (drug eluting stent) and BMS (bare metal stents). The final round results:
Target lesion revascularisation
DES = 6.1%
BMS = 16.3%
Major adverse cardiac events
DES = 11.5%
BMS = 18.2%
DES = 6.1%
BMS = 1.9%
Note that even though cardiac death was higher in the DES group, rate of reinfarction and all cause mortality was the same. Risk of stent thrombosis was also similar between the two groups.
So, what do you get out of this? You get less cardiac events with a DES, and less need for revascularisation, but a higher risk of cardiac death – but not from MI or stent thrombosis. Quite a few other of these comparative studies (HORIZONS, SESAMI, PASSION) between stents haven’t found that same result, although others have found this downside to DES before (such as with GRACE). The authors do say that the ‘…very low cardiac mortality in our BMS group is hard to interpret, and the excess DES mortality…might have occurred by chance.”
We should point out – there’s a Cochrane review from a couple of months ago (May 2010) that looks at this stent fight in angina or acute coronary syndromes from 47 RCTs- they found that there’s no difference for death (overall), AMI, or thrombosis, but there was less revascularisation with DES.
Sounds like we need a rather large high quality meta-analysis of stents and STEMI to answer some of these questions – in the meantime, check out the articles above, then read this one over here.