In a nutshell
This study compared the efficacy of bare metal stents alone to bare metal stents plus prednisone and drug-eluting stents in advanced coronary artery disease.
Some background
In coronary artery disease, blood vessels are blocked by the buildup of plaque, or fats from the blood stream. This is treated by a process of revascularization, whereby blood flow through the artery is restored. Bare metal stents (mesh-like tube of thin wire) can be used to re-open blocked vessels and restore blood flow, but inflammation in the body can cause a vessel to close again (restenosis). Therefore, patients with bare metal stents might benefit from also taking an oral anti-inflammatory drug, such as prednisone (Deltasone). Alternatively, drug-eluting stents can be placed in an artery to slowly release drugs that block restenosis. As each method is associated with different benefits and drawbacks, this study aimed to demonstrate the clinical effects of each of the three methods.
Methods & findings
This study compared 375 coronary artery disease patients’ event-free survival, the likelihood of patient survival without major complications. Patients were separated into three groups: 125 were treated with bare metal stents, 122 were treated with bare metal stents plus prednisone, and 127 were treated with drug-eluting stents. The drug-eluting stents contained either paclitaxel (Taxol: inhibits cell division) or sirolimus (Rapamune: suppresses the immune system and therefore the inflammatory response).
At one year, bare metal stent patients had a significantly worse event-free survival rate (80%) than patients who were treated with the addition of prednisone (88%) or drug-eluting stents (88.8%).
Similar trends in event-free survival were seen at four years, with bare metal stent patients having a lower event-free survival rate (75.3%) compared to those patients who were treated with the addition of prednisone (84.1%) or drug-eluting stents (80.6%).
The need for further target vessel revascularization in the long term was higher in the bare metal stent patients (23.2%) than in those treated additionally with prednisone (13.6%) or drug-eluting stents (15.2%), but these differences were not statistically significant.
The bottom line
Both bare metal stents plus prednisone and drug-eluting stents are superior to bare metal stent alone at preventing long-term complications in revascularization of advanced coronary artery disease.
The fine print
Both bare metal stent plus prednisone and drug-eluting stent were compared to bare metal stent alone, but not to each other.
Published By :
European Heart Journal
Date :
Jun 25, 2013
