Adding more confusion to the issue safety of stents. Its a war among manufacturers and paid industry purchased scientists. We should concentrate on prevention leave them to fight for a non-issue. ================================== Bare-Metal Stent Safety Is a Myth: DAPT Secondary Analysis Sue Hughes November 19, 2014 CHICAGO, IL — Drug-eluting stents (DES) are not associated with increased rates of stent thrombosis or major ischemic events compared with bare-metal stents, according to the results of a propensity analysis based the DAPT study[1]. Similar results were seen for major ischemic events. Some observers, however, were cautious in interpreting whether propensity matching could provide a level playing field for the comparison. Presenting data from a secondary analysis of the DAPT trial at the American Heart Association (AHA) 2014 Scientific Sessions, Dr Dean Kereiakes (Christ Hospital Heart & Vascular Center/Lindner Research Center Cincinnati, OH) said: What Ive learned from this is the myth of bare-metal stents—they are not safer. He added: The practice that we see every day of colleagues putting in bare-metal stents because they perceive them to be safer and they perceive that dual antiplatelet therapy could be shorter—Im not sure thats the right thought process. Dr Dean Kereiakes Kereiakes also presented randomized data from the 1687 patients who received bare-metal stents in the DAPT trial and, like the main analysis in patients with DES, were randomized to either a further 18 months of thienopyridine therapy or placebo, all patients continuing on aspirin. Similar to the main result in the DES population reported earlier at the AHA meeting, this analysis also showed a relative reduction in stent-thrombosis rate with the extended treatment in the bare-metal-stent cohort, although the difference did not reach statistical significance. Kereiakes concluded: In patients given bare-metal stents, prolonged thienopyridine therapy (30 months or longer) may provide durable ischemic benefit in addition to increased bleeding risk and requires further study. In his introduction, Kereiakes noted that bare-metal stents are a commonly used alternative to DES, particularly for patients presenting with acute coronary syndromes or in whom dual antiplatelet therapy has perceived increased bleeding risk. The DAPT study included patients who received bare-metal stents so it could determine whether such stents and DES differ in their associated risks of stent thrombosis and major adverse cardiovascular and cerebrovascular events (MACCE) or in optimal duration of dual antiplatelet therapy. The incidence of stent thrombosis and ischemic events was compared between the two types of stents in a propensity-matched analysis. This analysis, according to Kereiakes, pointed to a lower rate of stent thrombosis and major adverse cardiovascular and cerebrovascular events with the DES. Propensity Matched Analysis of Stent Thrombosis and Ischemic Events on DES vs Bare-Metal Stents Outcome DES, n=8308 (%) Bare-metal stents, n=1718 (%) P , noninferiority P , difference Stent thrombosis 1.7 2.6
Posted on: Fri, 21 Nov 2014 06:30:36 +0000
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