Catheterization and Cardiovascular Interventions

Feng Qian*, Ye Zhong, and Edward L. Hannan



Objectives: To study four-year outcomes for patients receiving either bare-metal stents (BMS) or everolimus-eluting stents (EES) and to evaluate the comparative effectiveness of BMS versus EES in six “off-label” and two “high-risk” patient subgroups.
Background: BMS and EES (a second generation of drug-eluting stent) are used in contemporary practice to treat coronary artery disease. However, little is known about long-term comparative effectiveness between BMS and EES.
Methods: Using the New York State (NYS) cardiac registries, statewide hospital discharge data, the National Death Index, and the U.S. Census file, we assessed four-year outcomes of BMS versus EES in patients receiving either BMS or EES from July 2008 through December 2009. The outcomes included all-cause mortality, acute myocardial infarction (AMI), target-lesion PCI (TLPCI), and target-vessel coronary artery bypass graft (TVCABG) surgery for a follow-up period of four years (median follow-up of 3.6 years). We compared 9,290 propensity score matched pairs with further adjustment using Cox proportional hazards regression.
Results: Compared with patients receiving BMS, patients receiving EES had a lower rate of four-year mortality (adjusted hazard ratio : 0.58, 95% confidence interval : 0.54–0.63), AMI (AHR: 0.68, 95% CI: 0.61–0.76), TLPCI (AHR: 0.67, 95% CI: 0.60–0.75), and TVCABG (AHR, 0.53, 95% CI: 0.43–0.65). For “off-label” and “high-risk” subgroups, EES was associated with decreased mortality and generally better AMI, TLPCI, and TVCABG outcomes relative to BMS.
Conclusions: Compared with BMS use, EES use was associated with better four-year outcomes.

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* Denotes CSDA Associates, Affiliates, and Staff