Drug-Eluting or Bare-Metal Stents for Left Anterior Descending or Left Main Coronary Artery Revascularization
Journal of the American Heart Association
; 10(20): 018828, Oct. 2021. graf, tab
Article
in English
| CONASS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP
| ID: biblio-1344305
Responsible library:
BR79.1
ABSTRACT
BACKGROUND:
New-generation drug-eluting stents (DES) reduce target-vessel revascularization compared with bare-metal stents (BMS), and recent data suggest that DES have the potential to decrease the risk of myocardial infarction and cardiovascular mortality. We evaluated the treatment effect of DES versus BMS according to the target artery (left anterior descending [LAD] and/or left main [LM] versus other territories [no-LAD/LM]). METHODS ANDRESULTS:
The Coronary Stent Trialist (CST) Collaboration gathered individual patient data of randomized trials of DES versus BMS for the treatment of coronary artery disease. The primary outcome was the composite of cardiac death or myocardial infarction. Hazard ratios (HRs) with 95% CIs were derived from a 1-stage individual patient data meta-analysis. We included 26 024 patients across 19 trials 13 650 (52.4%) in the LAD/LM and 12 373 (47.6%) in the no-LAD/LM group. At 6-year follow-up, there was strong evidence that the treatment effect of DES versus BMS depended on the target vessel (P interaction=0.024). Compared with BMS, DES reduced the risk of cardiac death or myocardial infarction to a greater extent in the LAD/LM (HR, 0.76; 95% CI, 0.680.85) than in the no-LAD/LM territories (HR, 0.93; 95% CI, 0.831.05). This benefit was driven by a lower risk of cardiac death (HR, 0.83; 95% CI, 0.700.98) and myocardial infarction (HR, 0.74; 95% CI, 0.650.85) in patients with LAD/LM disease randomized to DES. An interaction (P=0.004) was also found for all-cause mortality with patients with LAD/LM disease deriving benefit from DES (HR, 0.86; 95% CI, 0.760.97).CONCLUSIONS:
As compared with BMS, new-generation DES were associated with sustained reduction in the composite of cardiac death or myocardial infarction if used for the treatment of LAD or left main coronary stenoses.
Full text:
Available
Collection:
National databases
/
Brazil
Health context:
Sustainable Health Agenda for the Americas
Health problem:
Goal 5: Medicines, vaccines and health technologies
Database:
CONASS
/
Sec. Est. Saúde SP
/
SESSP-IDPCPROD
Main subject:
Stents
/
Drug-Eluting Stents
Type of study:
Controlled clinical trial
Language:
English
Journal:
Journal of the American Heart Association
Year:
2021
Document type:
Article
Institution/Affiliation country:
Cardiac Unit, Cardiology Fellow Training Program, Otamendi Hospital, Buenos Aires School of Medicine/AR
/
Department of Advanced Biomedical Sciences, University of Naples Federico II/IT
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Department of Cardiology, Bern University Hospital/CH
/
Department of Cardiology, Clinical Center of Serbia, University of Belgrade/RS
/
Department of Cardiology, Hôpital Cochin/FR
/
Department of Cardiology, Isala Heart Centre/NL
/
Department of Cardiology, Kerckhoff Klinik/DE
/
Department of Cardiology, Maastricht University Medical Center/NL
/
Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals/GB
/
Department of Cardiology, University Hospital Basel, University of Basel/CH