Is This the Beginning of the End for Bare-Metal Stents?

Summary and Comment |
August 30, 2016

Is This the Beginning of the End for Bare-Metal Stents?

  1. Howard C. Herrmann, MD

A large randomized trial shows no difference in rates of death or myocardial infarction or in quality of life after drug-eluting stents or bare-metal stents.

  1. Howard C. Herrmann, MD

Drug-eluting stents (DES) reduce restenosis better than bare-metal stents (BMS), but rates of death and myocardial infarction (MI) with the latest generations of both devices have not been adequately compared. In the current study, which involved all eight centers for percutaneous coronary intervention in Norway, 9013 patients with both stable angina and an acute coronary syndrome were randomized to receive DES or BMS and were followed for a median of 5 years. All patients received aspirin indefinitely and clopidogrel for 9 months.

At 6 years of follow-up, the primary composite endpoint of all-cause mortality and nonfatal MI did not differ significantly between groups (DES group, 16.6%; BMS group, 17.1%). The groups also did not differ in cardiac mortality, stroke, and quality-of-life measures. However, target-lesion revascularization was significantly lower with DES than with BMS (hazard ratio, 0.47), and definite stent thrombosis occurred in 0.8% of DES patients versus 1.2% of BMS patients (P=0.0498).

Comment

This is the largest randomized study to date comparing contemporary DES and BMS. It demonstrates similar overall outcomes with each stent type at 6 years, providing rationales to support the use of either one. The lower rate of restenosis and stent thrombosis with DES may prompt many interventionalists (including myself) to abandon BMS for most patients altogether, except for those who cannot complete an adequate (but yet to be determined) period of dual antiplatelet therapy. In the future, some patients in the latter group may be candidates for DES with bioabsorbable polymers or struts.

Editor Disclosures at Time of Publication

  • Disclosures for Howard C. Herrmann, MD at time of publication Consultant / Advisory board Gerson Lehrman Group; Leerink Swann; Wells Fargo; Edwards Lifesciences; Coleman Research Group Speaker's bureau American College of Cardiology Foundation; American Association for Thoracic Surgery; Beaumont Hospital Cardiovascular Research Foundation; Inova Health Care; Medintelligence; Medinol; Society for Cardiovascular Angiography and Interventions; Northwestern University; Washington Hospital St. Louis; Westchester Medical Center Equity Micro Interventional Devices, Inc. Grant / Research support Abbott Vascular; Boston Scientific; Edwards Lifesciences; St. Jude Medical; Medtronic; Gore; Siemens; Cardiokinetix; University of Laval; Mitraspan Editorial boards Catheterization and Cardiovascular Interventions; Circulation: Cardiovascular Interventions; Journal of Interventional Cardiology; Journal of Invasive Cardiology; Journal of the American College of Cardiology

Citation(s):

Reader Comments (3)

RAVI RAO Physician, Oncology, pvt practice

So, if 2 modalities are equal in outcomes, why not pick the cheaper one (bare metal stents)? You would also obviate the need for dual anti-plt agent tx, and the attendant risks of GI bleeding, right? The conclusions drawn are faulty..

Antonio Mansur, MD, PhD Physician, Cardiology, Heart Institute (InCor), University of São Paulo Medical School

The claim of Dr. Herrmann that is the beginning of the end of BMS was very strong after the Norwegian study. The study's message was another, that is, there is still enough room for the use of BMS in special for the developing countries where the cost-benefit should always be taken into account.

Vasiliy Vlassov, MD Other, Epidemiology/Statistics, moscow
Competing Interests: No

it looks like commentator said the opposite to what he intended to say.
"The lower rate of restenosis and stent thrombosis with DES may prompt many interventionalists (including myself) to abandon BMS for most patients altogether, except for those who cannot complete an adequate (but yet to be determined) period of dual antiplatelet therapy. In the future, some patients in the latter group may be candidates for DES with bioabsorbable polymers or struts."
Otherwise the logic is some where lost

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