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Heart Attack? Drug-Coated Stents Best
Sept. 25, 2008 - Drug-coated stents are safe for all heart attack patients, a large study shows.
The 7,217-patient study was designed to address worries that using newer drug-coated stents instead of older bare-metal stents increases the risk of death for some heart attack patients.
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Not only did the drug-coated stents turn out to be safe, they turned out to be safer. No matter what kind of heart attack a patient had, the two-year risk of death was somewhat less if drug-coated stents were used."We observed small absolute differences in mortality that favored drug-[coated] stents," report Brigham and Women's researcher Laura Mauri, MD, and colleagues. "These observations were consistent for all [heart attacks] and for both subtypes of [heart attack]."
Stents are thin mesh tubes used to prop open clogged arteries. Drug-coated stents -- doctors call them drug-eluting stents -- give off a medication that helps keep the artery from reclogging.
However, the drug increases the risk that a deadly blood clot will form, so patients have to stay on blood-thinning drugs for a year after getting a drug-coated stent.
A recent study suggested that patients with a kind of heart attack with a specific electrocardiogram signature -- ST-segment elevation -- have twice the risk of dying if they get a drug-coated stent instead of a bare-metal stent.
Mauri and colleagues looked at two-year outcomes for heart attack patients who got drug-coated stents (4,016 patients) or bare-metal stents (3,201 patients). There were patients in both groups with and without ST-segment elevation.
The findings:
- Overall, the two-year risk of death was 10.7% with drug-coated stents and 12.8% with bare-metal stents.
- For patients with ST-segment elevation, the two-year risk of death was 8.5% with drug-coated stents and 11.6% with bare-metal stents.
- For patients without ST-segment elevation, the two-year risk of death was 12.8% with drug-coated stents and 15.6% with bare-metal stents.
Mauri and colleagues note that their look-back study was designed to see whether drug-coated stents were safe. Only a look-ahead clinical trial can prove whether one stent really saves more lives than another.
The study findings appear in the Sept. 25 issue of The New England Journal of Medicine.
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