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Rapid adoption of drug-eluting stents: clinical practices and outcomes from the early drug-eluting stent era.

Publication ,  Journal Article
Lopez, JJ; Keyes, MJ; Nathan, S; Piana, R; Pencina, M; Dhar, G; Marso, S; Rao, S; Shammo, S; Marquardt, W; Cohen, DJ; Kleiman, NS
Published in: Am Heart J
October 2010

OBJECTIVES: We sought to evaluate the early drug-eluting stent (DES) era, characterized by widespread device use. BACKGROUND: Contemporary clinical practice incorporating more selective DES use can only be assessed by understanding the early DES era. METHODS: All patients receiving DES during the first 3 waves of the Evaluation of Drug Eluting Stents and Ischemic Events (EVENT) Registry (2004-2006) were evaluated. The primary end point was a composite of death, myocardial infarction (MI), and urgent revascularization at discharge and death, MI, or target lesion revascularization (TLR) at 1 year. The composite end point at each time point was compared across waves. Multivariable logistic regression was used for in-hospital outcomes and multivariable Cox regression was used for 1-year end points. RESULTS: Ninety-two percent of EVENT patients received at least one DES. One third of patients were treated for Acute Coronary Syndromes (ACS) (33.8%), and later waves included lower lesion complexity. Across waves there was more frequent clopidogrel loading, a decrease in heparin and an increase in bivalirudin use (all P < .01). The primary composite end point of in-hospital death, MI or urgent revascularization occurred in 7.2% of patients, and did not differ across waves. Despite remarkably high levels of routine DES usage, the composite end point of death, MI, or TLR at 1 year averaged 13.5% and did not differ across waves. After adjustment, no statistically significant effect of wave on composite bleeding (P = .068) as well as in-hospital TLR (P = .053) was noted. At 1 year, wave was associated with a lower likelihood of TLR in the adjusted model (HR 0.81, P = .03). CONCLUSIONS: The high-adoption DES era was associated with favorable outcomes, decreasing bleeding rates and changes in antithrombotic approach.

Duke Scholars

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

October 2010

Volume

160

Issue

4

Start / End Page

767 / 774

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Sirolimus
  • Retrospective Studies
  • Paclitaxel
  • Middle Aged
  • Male
  • Incidence
  • Immunosuppressive Agents
 

Citation

APA
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ICMJE
MLA
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Lopez, J. J., Keyes, M. J., Nathan, S., Piana, R., Pencina, M., Dhar, G., … Kleiman, N. S. (2010). Rapid adoption of drug-eluting stents: clinical practices and outcomes from the early drug-eluting stent era. Am Heart J, 160(4), 767–774. https://doi.org/10.1016/j.ahj.2010.06.048
Lopez, John J., Michelle J. Keyes, Sandeep Nathan, Robert Piana, Michael Pencina, Gaurav Dhar, Steven Marso, et al. “Rapid adoption of drug-eluting stents: clinical practices and outcomes from the early drug-eluting stent era.Am Heart J 160, no. 4 (October 2010): 767–74. https://doi.org/10.1016/j.ahj.2010.06.048.
Lopez JJ, Keyes MJ, Nathan S, Piana R, Pencina M, Dhar G, et al. Rapid adoption of drug-eluting stents: clinical practices and outcomes from the early drug-eluting stent era. Am Heart J. 2010 Oct;160(4):767–74.
Lopez, John J., et al. “Rapid adoption of drug-eluting stents: clinical practices and outcomes from the early drug-eluting stent era.Am Heart J, vol. 160, no. 4, Oct. 2010, pp. 767–74. Pubmed, doi:10.1016/j.ahj.2010.06.048.
Lopez JJ, Keyes MJ, Nathan S, Piana R, Pencina M, Dhar G, Marso S, Rao S, Shammo S, Marquardt W, Cohen DJ, Kleiman NS. Rapid adoption of drug-eluting stents: clinical practices and outcomes from the early drug-eluting stent era. Am Heart J. 2010 Oct;160(4):767–774.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

October 2010

Volume

160

Issue

4

Start / End Page

767 / 774

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Sirolimus
  • Retrospective Studies
  • Paclitaxel
  • Middle Aged
  • Male
  • Incidence
  • Immunosuppressive Agents