Long term follow up of additional Swedish registry data does not indicate an increased mortality with drug-eluting stents but the benefit is limited and the risk of blood clots is sustained
"This is a unique presentation of the entire experience of the long-term outcome of treatment with different types of stents in an entire country from 2003 to 2006. Despite the increased risk of acute blood clot formation in the stents which may lead to myocardial infarction there was no increase in mortality at long term follow-up.
The risk of re narrowing of the treated vessel and the need for repeated interventions was lower with the drug eluting stents but the difference was lower than previously shown in randomized comparative studies with selected patients undergoing mandated angiography control. Our opinion is therefore that drug eluting stents are not dangerous but they should be used with selection considering the individual risk of re-narrowing and the patients ability to tolerate clot inhibiting drugs for a long period of time as well as the increased cost associated with this treatment" states the investigators from Uppsala Clinical Research Centre (UCR).
The Swedish Coronary Angiography and Angioplasty Registry (SCAAR) records consecutive patients from all centres performing coronary angiography and percutaneous coronary interventions (PCI) in Sweden. Funding is obtained from the Swedish Health Authorities and the registry is completely independent of commercial funding. The technology is developed and administered by Uppsala University Clinical Research Centre (UCR). The present study included all 13786 patients in Sweden who had undergone implantation with drug eluting stent as compared to the 21480 treated with bare metal stents from January 1, 2003 until December 31, 2005 for whom at least one year of follow-up was available. Follow up was achieved by merging with other National registries. There was a range in the use of drug eluting stent from 1% to 52% between different hospitals, which was the factor with the largest influence on the selection of type of stent. During the entire study period 2957 myocardial infarctions and 1424 deaths occurred which were the outcome events used in the statistical analysis. The outcome results were adjusted for differences in background characteristics.
Today balloon dilatation with implantation of a stent is a very
common and effective treatment of patients with heart attacks and
angina pectoris caused by narrowing of the coronary vessels.
Compared to balloon dilatation alone the use of stents has improved
the safety of the procedures and reduces the need for recurrences.
Over the last 4 - 5 years the stents have been covered by drugs
that further reduce the reoccurrence of narrowing and the need for
new procedures. Treatment with such "drug-eluting" stents has
become very frequent and has been used in around 8 million patients
The most commonly used drug-eluting stents are based on the drugs Paclitaxel (Taxus express® and Taxus Liberté®, Boston Scientific inc.) and Sirolimus (Cypher® and Cypher Select® - Cordis, Johnson &Johnson inc.)
The European Society of Cardiology (ESC)
The ESC represents nearly 53,000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.
The ESC achieves this through a variety of scientific and educational activities including the coordination of: clinical practice guidelines, education courses and initiatives, pan-European surveys on specific disease areas and the ESC Annual Congress, the largest medical meeting in Europe. The ESC also works closely with the European Commission and WHO to improve health policy in the EU.
The ESC comprises 3 Councils, 5 Associations, 19 Working Groups, 50 National Cardiac Societies and an ESC Fellowship Community (Fellow, FESC; Nurse Fellow, NFESC). For more information on ESC Initiatives, Congresses and Constituent Bodies see www.escardio.org.
European Society of Cardiology, The European Heart House 2035 Route des Colles, B.P. 179 - Les Templiers, Sophia Antipolis F-06903 France
About the Author(s)
Professor Stefan James
Uppsala Clinical Research Centre
(Jörg Carlsson, Johan Lindbäck, Tage Nilsson, Ulf Stenestrand, Lars Wallentin and Bo Lagerqvist for the SCAAR Study Group)
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