PURPOSE: Drug-eluting coronary stents (DES) have a higher rate of late stent thrombosis than bare-metal stents (BMS) in randomized clinical trials. The impact of late stent thrombosis on survival is uncertain. We hypothesized that DES might be chosen for more complex and high-risk patients than BMS outside the clinical trial setting.
METHODS: We compared baseline clinical and laboratory characteristics between the last 200 patients who received BMS prior to the onset of DES in June 2003 and the first 200 patients who received DES (excluding those for whom full data were unavailable) at the New York Veterans Affairs Hospital. Data are expressed as means ± standard deviations. The student's t-test was used for comparisons between groups.
RESULTS: There were no significant differences between groups in age (66.0 ± 10.3 vs. 66.5 ± 10.7, p =0.19) or ejection fraction (50.6 ± 9.6 vs. 51.9 ± 9.0, p = 0.07). Patients who received DES had higher peri-procedural serum glucose (140 ± 68 vs. 119 ± 35, p < 0.0001) and blood urea nitrogen (BUN) (20.4 ± 11.6 vs. 17.9 ± 7.7, p = 0.003). DES patients also had lower total cholesterol (165 ± 42 vs. 172 ± 38, p = 0.04) and LDL (95 ± 32 vs. 102 ± 31, p = 0.007).
CONCLUSION: As expected, lipid profiles improved over time, consistent with more aggressive treatment guidelines for dyslipidemia in coronary disease patients. Higher glucose and BUN in DES patients suggest that the availability of DES led to greater use of PCI in diabetics, a population with a high rate of restenosis with BMS.
CLINICAL IMPLICATIONS: We have previously shown that elevations in peri-procedural glucose and BUN are risk factors for mortality after PCI. Future studies evaluating the impact of DES on clinical outcomes after PCI will have to take into account the higher risk profile of contemporary DES patients as well as improved management of lipids.
DISCLOSURE: Edward Rachofsky, No Financial Disclosure Information; No Product/Research Disclosure Information