Are current bare-metal stents still an option in selected patient populations?

Abstract

Background: Drug-eluting stents (DES) and bare-metal stents (BMS) share the same platform. Due to lower restenosis rates, DES are the standard of care. This study sought to establish if BMS outcomes were equivalent to DES in certain lesion and vessel types with inherently low risk of in-stent restenosis (ISR).

Methods: A total of 4,495 patients who underwent percutaneous coronary intervention in the Melbourne Interventional Group Registry (2005–2017) with distinct BMS and DES use were analysed. Vessel size ≥2.5 mm and lesion length ≤18 mm were included. Diabetics were excluded. Follow-up and mortality outcomes were derived from National Death Index (NDI) data. Mortality hazards ratios (HR) were determined by Cox proportional hazards analysis.

Results: The BMS patients were older (62.4 vs 61.5 years, p = 0.01), had more atrial fibrillation (5.8% vs 2.5%, p < 0.005), and New York Heart Association class III or IV (21.9% vs 15.2%, p < 0.005). The BMS patients more commonly had ST-elevation myocardial infarction presentation (48.4% vs 41.5%, p < 0.005) and severe heart failure (Killip class III or IV 1.4% vs 0.7%, p = 0.027). Mean follow-up was 6.8 ± 3.5 and 4.5 ± 3.6 years in BMS and DES cohorts, respectively. The NDI mortality rates were 13.2% in BMS and 6.8% in DES patients, but the multivariable adjusted-HR was not significantly different with HR = 1.20 (95% CI 0.94–1.53, p = 0.140).

Conclusions: The BMS mortality rates were higher. However, BMS patients were older, with greater comorbidity and presentation acuity. Following adjustment, BMS was not an independent mortality predictor and remained relevant in selected patients, particularly those requiring truncated dual antiplatelet therapy.