Reduction in mortality and target-lesion revascularisation at 2 years: A comparison between drug-eluting stents and conventional bare-metal stents in the “real world”

2009 ◽  
Vol 132 (3) ◽  
pp. 398-404 ◽  
Author(s):  
Albert E. Alahmar ◽  
Antony D. Grayson ◽  
Mohammed Andron ◽  
Mohaned Egred ◽  
Elved D. Roberts ◽  
...  
Keyword(s):  
Real World ◽  
Bare Metal Stents ◽  
Target Lesion ◽  
Drug Eluting Stents ◽  
Metal Stents ◽  
Bare Metal ◽  
Target Lesion Revascularisation ◽  
The Real ◽  
Drug Eluting

Drug-eluting stents for treatment of focal infrapopliteal lesions

VASA ◽  
2012 ◽  
Vol 41 (2) ◽  
pp. 90-95 ◽  
Author(s):  
Rastan ◽  
Noory ◽  
Zeller
Keyword(s):  
Limb Salvage ◽  
Bare Metal Stents ◽  
Target Lesion ◽  
Drug Eluting Stents ◽  
Metal Stents ◽  
Target Lesion Revascularisation ◽  
Randomized Studies ◽  
Drug Eluting ◽  
The Mean

We have investigated the role of drug-eluting stents on patency rates after treatment of focal infrapopliteal lesions in patients with intermittent claudication and critical limb ischemia. Reports indicate that drug-eluting stents reduce the risk of restenosis after percutaneous infrapopliteal artery revascularization. A Pub Med, EMBASE, Cochrane database review search of non-randomized studies investigating patency rates, target lesion revascularisation rates, limb salvage rates and mortality rates in an up to 3-year follow-up period after drug-eluting stent placement was conducted. In addition, preliminary results of randomized studies comparing drug-eluting stents with bare-metal stents and plain balloon angioplasty in treatment of focal infrapopliteal lesions were included in this review. A total of 1039 patients from 10 non-randomized and randomized studies were included. Most commonly used drug-eluting stents were sirolimus-eluting. The mean follow-up period was 12.6 (range 8 - 24). The mean 1-year primary patency rate was 86 ± 5 %. The mean target lesion revascularization rate and limb salvage rate was 9.9 ± 5 % and 96.6 %±4 %, respectively. Results from non-randomized and preliminary results from prospective, randomized trials show a significant advantage for drug-eluting stents in comparison to plain balloon angioplasty and bare-metal stents concerning target lesion patency and in parts target lesion revascularisation. No trial reveals an advantage for drug-eluting stents with regard to limb salvage and mortality.

Abstract 20233: Does Evidence Influence Practice in the Real World? Secular Trends in Indication for PCI and Use of Drug-Eluting vs. Bare-Metal Stents From 2006-2012

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Elizabeth B Pathak ◽  
Jason L Salemi ◽  
Amit P Pathak
Keyword(s):  
Real World ◽  
Bare Metal Stents ◽  
Metal Stents ◽  
Bare Metal ◽  
Discharge Data ◽  
The Real ◽  
Primary Indication ◽  
Stable Coronary Heart Disease ◽  
Before And After ◽  
Drug Eluting

Introduction: In this study, we examined the real-world impact of research evidence on the use of and indications for percutaneous coronary intervention (PCI) (before and after COURAGE Trial publication) and the choice of drug eluting stents (DES) vs. bare metal stents (BMS) (before and after FDA warnings about risk of DES thrombosis). Methods: We used hospital discharge data from Florida to calculate the distribution of primary indication for PCI and the % of PCI patients who received DES, BMS, or no stent on a quarterly basis from Jan 2006 - Jun 2012. We plotted stent trends separately for patients with principal diagnosis of STEMI (n=66,054), NSTEMI/ICS (n=140,886), and stable CHD (n=117,307). Results: Since 2006, the % of PCIs with a primary indication of either STEMI or NSTEMI has steadily increased, while the % with an indication of stable CHD declined from 45% to 28%. In early 2006, DES were used in 86.9% of NSTEMI patients, 87.5% of stable CHD patients, and 81.4% of STEMI patients. DES use first declined in all diagnosis groups in Q3 2006, coinciding with the release of meta-analysis results showing higher risk of late stent thrombosis for DES vs. BMS. The lowest rate of DES usage was reached in Q1 2008 (45% for STEMI, 63% for NSTEMI, 67% for stable CHD). However, by Q2 2012, DES use had increased to 60% in STEMI cases, 75% in NSTEMI cases, and 76% in stable CHD cases. The percent of PCI patients who received no stent has remained stable at < 9% since 2006, regardless of diagnosis. Conclusions: The COURAGE Trial showed no benefit of PCI over medical treatment in stable coronary heart disease (CHD). From 2006-2012, the proportion of PCIs with an indication of stable CHD declined from 45% to 28%, indicating a real-world response to evidence. Similarly, following controversy about long-term effects of DES, off-label use, and patient compliance with thienopyridines which began in late 2006, there was an immediate resurgence in use of BMS, especially for STEMI. However, the proportion of patients receiving DES has steadily increased since early 2008, regardless of primary indication. More research on the influence of provider and hospital characteristics on response to evidence is needed.

scholarly journals CE4 COST EFFECTIVENESS OF DRUG ELUTING STENTS (DES) COMPARED TO BARE METAL STENTS (BMS) USING “REAL WORLD” DATA

2006 ◽  
Vol 9 (3) ◽  
pp. A8
Author(s):  
G Blackhouse ◽  
J Bowen ◽  
JE Tarride ◽  
R Hopkins ◽  
D O'Reilly ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Real World ◽  
Bare Metal Stents ◽  
Drug Eluting Stents ◽  
Metal Stents ◽  
Bare Metal ◽  
Real World Data ◽  
World Data ◽  
Drug Eluting

Results in Complex Multivessel and Multilesion PCI in Patients Treated with a Combination of Drug Eluting Stents and Bare Metal Stents in Real World Practice

2008 ◽  
Vol 17 ◽  
pp. S163
Author(s):  
Ravinder Batra ◽  
Akshay Mishra ◽  
Rohan Jayasinghe ◽  
Sharmalar Rajendran ◽  
Naylin Bissessor ◽  
...  
Keyword(s):  
Real World ◽  
Bare Metal Stents ◽  
Drug Eluting Stents ◽  
Metal Stents ◽  
Bare Metal ◽  
Drug Eluting

Comparative Effectiveness of Plain Balloon Angioplasty, Bare Metal Stents, Drug-Coated Balloons, and Drug-Eluting Stents for the Treatment of Infrapopliteal Artery Disease

2016 ◽  
Vol 23 (6) ◽  
pp. 851-863 ◽  
Author(s):  
Konstantinos Katsanos ◽  
Panagiotis Kitrou ◽  
Stavros Spiliopoulos ◽  
Athanasios Diamantopoulos ◽  
Dimitris Karnabatidis
Keyword(s):  
Wound Healing ◽  
Balloon Angioplasty ◽  
Evaluation System ◽  
Meta Analysis ◽  
Bare Metal Stents ◽  
Target Lesion ◽  
Drug Eluting Stents ◽  
Metal Stents ◽  
Bare Metal ◽  
Drug Eluting

Purpose: To report a Bayesian network meta-analysis of randomized controlled trials (RCTs) comparing bare metal stents (BMS), paclitaxel-coated balloons (PCBs), and drug-eluting stents (DES) with balloon angioplasty (BA) or with each other in the infrapopliteal arteries. Methods: Sixteen RCTs comprising 1805 patients with 1-year median follow-up were analyzed. Bayesian random effects binomial models were employed (WinBUGS). Relative treatment effects were expressed as odds ratios (ORs) with 95% credible intervals (CrI), and the cumulative rank probabilities were calculated to provide hierarchies of competing treatments. Quality of evidence (QoE) was assessed with the GRADE (grading of recommendations assessment, development, and evaluation) system. Sensitivity, heterogeneity, and consistency analyses were performed. Results: There was high QoE that infrapopliteal DES significantly reduced restenosis compared with BMS (OR 0.26, 95% CrI 0.12 to 0.51) and BA (OR 0.22, 95% CrI 0.11 to 0.45). Likewise, DES significantly reduced target lesion revascularization (TLR) compared with BA (OR 0.41, 95% CrI 0.22 to 0.75) and BMS (OR 0.26, 95% CrI 0.15 to 0.45). Paclitaxel-coated balloons also reduced TLR compared with BA (OR 0.55, 95% CrI 0.34 to 0.90) and BMS (OR 0.35, 95% CrI 0.18 to 0.67), but QoE was low to moderate. BA had lower TLR than BMS (OR 0.63, 95% CrI 0.40 to 0.99) with high QoE. DES was the only treatment that significantly reduced limb amputations compared with BA (OR 0.58, 95% CrI 0.35 to 0.96), PCB (OR 0.51, 95% CrI 0.26 to 0.98), or BMS (OR 0.38, 95% CrI 0.19 to 0.72) with moderate to high QoE. DES also significantly improved wound healing compared with BA (OR 2.02, 95% CrI 1.01 to 4.07) or BMS (OR 3.45, 95% CrI 1.41 to 8.73) with high QoE. Results were stable on sensitivity and meta-regression analyses without any significant publication bias or inconsistency. Conclusion: Infrapopliteal DES were associated with significantly lower rates of restenosis, TLR, and amputations and improved wound healing compared to BA and BMS. DES also significantly reduced amputations compared with PCB.

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