drug-eluting stents are associated with better outcomes compared to bare-metal stents in unstable...

A199JACC April 1, 2014

Volume 63, Issue 12

Acute Coronary Syndromes

drug-eluting StentS are aSSoCiated With better outComeS Compared to bare-metal StentS in unStable angina or non St-elevation myoCardial inFarCtion patientS undergoing perCutaneouS Coronary intervention

Poster ContributionsHall CSunday, March 30, 2014, 3:45 p.m.-4:30 p.m.

Session Title: Clinical Perspectives on Management of Non-ST-Segment Elevation Acute Coronary SyndromeAbstract Category: 3. Acute Coronary Syndromes: TherapyPresentation Number: 1225-238

Authors: Georges Ephrem, Venkatesan Vidi, Zia Rab, Michael Kim, Rajiv Jauhar, Perwaiz Meraj, Hofstra North Shore-LIJ School of Medicine at North Shore-LIJ Health System, New Hyde Park, NY, USA

background: The 2011 ACCF/AHA/SCAI Guidelines for Percutaneous Coronary Intervention (PCI) considered drug-eluting stents (DES) as a useful alternative to bare-metal ones (BMS). The hypotheses of this study are that the use of DES is non-random in unstable angina (UA) or non ST-elevation myocardial infarction (NSTEMI) patients undergoing PCI and that DES use is associated with better outcomes.

methods: Prospectively-collected data of UA/NSTEMI patients undergoing PCI from 01/01/2011 till 03/31/2013 at 2 tertiary care centers in New York was analyzed. The results were confirmed with propensity-score-adjusted analysis. The primary endpoint was death (index admission or 30-day), the secondary adverse outcome (composite of death, dissection, perforation, myocardial infarction, cerebrovascular accident, bleeding, transfusion, and coronary artery bypass graft).

results: Of the 4,687 study subjects, those with DES (n = 4,269 (91%)) were on average younger, Asian, non-Hispanics, with private insurance, lesser prevalence of comorbidities, smaller vessel diameter, and had longer stents than patients with BMS. In propensity-score adjusted logistic regression analysis, DES use was associated with lower mortality and adverse outcomes (Table).

Conclusion: In UA/NSTEMI patients undergoing PCI, DES were more often deployed in younger, Asian, non-Hispanic patients, with private insurance and lesser comorbidities. DES use was associated with lower mortality and adverse outcomes.