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. DES are the standard of care in coronary revascularization due to lower restenosis rates.

Objectives/Aims

We aimed to establish if outcomes with BMS were equivalent to DES in certain lesion and vessel types with an inherently low risk of in-stent restenosis (ISR).

Method

4,495 patients undergoing PCI in the Melbourne Interventional Group Registry between 2005 and 2017 with distinct BMS and DES were analysed. Vessel size >2.5 mm and lesion length <18 mm were included. Diabetics were excluded.

Results

Patients receiving BMS were older (62.4 vs. 61.5 years, p=0.01), had more atrial fibrillation (5.8% vs. 2.5%, p<0.005), poor functional class III-IV (21.9% vs. 15.2%, p<0.005), cerebrovascular disease (5.2% vs. 3.0%, p=0.001) and chronic lung disease (10.9% vs. 8.6%, p=0.01). Presentation with ST-elevation myocardial infarction (48.4% vs. 41.5%, p<0.005) and severe heart failure (Killip class III/IV 1.4% vs 0.7%, p=0.03) was more common in the BMS group. 30-day mortality, myocardial infarction and repeat revascularization rates were not different in the two groups. Australian National Death Index (NDI)-linked mortality data projected lower survival estimates in BMS patients.

Implications/Outcomes for Planned Research Project

Greater consideration needs to be given to use of bare metal stents when clinically appropriate. This is of particular relevance given the importance of responsible resource utilisation in cardiology with increasing costs associated with managing coronary artery disease at a population level.

Final Thoughts

NDI-linked mortality data estimated lower survival in patients with BMS; however, this cohort was older with greater comorbidity and higher acuity presentation.