Real-World Analysis of PCI Patients in the British Columbia Cardiac Registry Compares DES and BMS

August 15, 2016—Long-term outcomes following the use of drug-eluting stents (DES) versus bare-metal stents (BMS) for primary percutaneous coronary intervention were reported in a real-world analysis of 11,181 patients in the British Columbia Cardiac Registry. M. Bilal Iqbal, MD, et al published the findings in Catheterization and Cardiovascular Interventions (CCI; 2016;88:24–35).

The investigators conducted an observational analysis in a real-world setting of patients with ST-elevation myocardial infarction (STEMI) treated with DES versus BMS. The analysis was rigorously adjusted for treatment selection bias. Target vessel revascularization (TVR) and mortality at 2 years were evaluated in 11,181 consecutive patients with acute STEMI who received either DES or BMS from 2008 to 2014 in the British Columbia Cardiac Registry.

The investigators concluded that when adjusting for measured and unmeasured factors, DES use was associated with reduced TVR and long-term survival beyond 1 year in patients with STEMI. This long-term survival was largely attributable to the second-generation DES. They stated that these real-world data are reassuring and support the use of DES for STEMI.

As summarized in CCI, multivariable-adjusted, propensity-matched, and inverse probability treatment–weighted analyses found DES to be associated with early and late survival up to 2 years but not TVR. However, when adjusting for measured and unmeasured confounders, instrumental variable (IV) analyses demonstrated that DES use was associated with reduced TVR up to 2 years (Δ = −6.7%; 95% confidence interval [CI], −10%, −3.4%; P < .001). DES use was not associated with mortality at 1 year (Δ = −2.3%; 95% CI, −5%, 0.4%; P = .1) but was associated with reduced mortality at 2 years (Δ = −5.4%; 95% CI, −8.3%, −2.5%; P < .001). Stratified IV analyses indicated that this long-term survival benefit was largely attributable to the second-generation DES, advised the investigators in CCI.