December 11, 2013

DynaMed EBM Journal Volume 8, Issue 50

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Physicians: .25 AMA PRA Category ICreditsTM

Family Physicians: .25 Prescribed credits

Nurse Practitioners: .25 Contact hours

Release Date: December 11, 2013

Expiration Date: December 11, 2014

Estimated Completion Time: 15 minutes

There is no fee for this activity.

To Receive Credit

In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.

Faculty Information

Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Senior Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company


Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.

No commercial support has been received for this activity.

Accreditation Statements

ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote EducationCompany and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: Enduring Material activity, DynaMed EBM Focus, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 7, 2012. Term of approval is for one year from this date with the option of yearly renewal. Each EBM Focus is worth .25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners.

Program ID: 1304159F


Last week 590 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 191 articles were added to DynaMed content.

Based on criteria for selecting "articles most likely to change clinical practice," one article was selected by the DynaMed Editorial Team.

In Women with Coronary Artery Disease, Newer Generation Drug-eluting Stents Associated with Reduced Risks of Myocardial Infarction and Target Vessel Revascularization Compared to Bare Metal and Early Generation Drug-eluting Stents
Reference: Lancet 2013 Dec 7;382(9908):1879 (level 2 [mid-level] evidence)

Drug-eluting stents are used to reduce the risk of restenosis in patients having percutaneous coronary intervention. A Cochrane review has demonstrated that, compared to bare metal stents, drug-eluting stents reduce the risk of target lesion revascularization (Cochrane Database Syst Rev 2010 May 12;(5):CD004587). However, a large majority of patients with coronary artery disease recruited for clinical studies are male, and these trials may not have been adequately powered to make similar conclusions in women. A recent pooled analysis of individual patient data has evaluated the long-term safety and efficacy of drug-eluting stents compared to bare-metal stents in a subgroup of female patients with coronary artery disease.

A systematic review identified 26 randomized trials comparing drug-eluting stents to bare-metal stents in 43,904 patients with coronary artery disease. Individual data from 11,557 women (26.3% of randomized patients) with a mean age 67 years and a mean follow-up time of 2.9 years were included in the analysis. Drug-eluting stents were classified as either newer generation stents (including everolimus-eluting Xience and Promus stents, zotarolimus-eluting Endeavor and Resolute stents, biolimus-eluting Biomatrix and Nobori stents, and sirolimus-eluting Yukon stents) or early generation stents (sirolimus-eluting Cypher stents and paclitaxel-eluting Taxus stents). At baseline, women receiving drug-eluting stents had lower rates of diabetes and higher rates of previous myocardial infarction compared to those receiving bare metal stents. The minimum duration of dual antiplatelet therapy ranged from 2 to 12 months.

The cumulative incidence of myocardial infarction over 3 years was 4.8% in 6,278 women who received newer generation drug-eluting stents, which was significantly lower than the rates in the other groups (6% of 4,171 women with early generation drug-eluting stents and 7.7% of 1,108 women with bare metal stents). Similarly, the cumulative incidence of target lesion revascularization over 3 years was significantly reduced in the newer generation drug-eluting stent group (6.3%) compared to the other groups (7.8% with early generation and 18.6% with bare metal stents). Newer generation drug-eluting stents were also associated with significantly lower rates of definite or probable stent thrombosis. The mortality rate was 5.7% overall, with no significant differences among treatment groups.

These findings are consistent with previous findings observed for drug-eluting stents in trials evaluating populations of both women and men. Collectively, these data support the use of newer generation drug-eluting stents compared to early generation drug-eluting stents or bare-metal stents in women with coronary artery syndrome having percutaneous coronary intervention. It is important to remember that drug-eluting stents are not the preferred option in patients unable to take dual antiplatelet therapy reliably for 12 months (Circulation. 2011 Dec 6;124(23):e574-651).

For more information, see the Drug-eluting stents topic in DynaMed.

Earn CME Credit for reading this e-Newsletter.
For more information on this educational activity, see the CME sidebar.

Call for Peer Reviews

We are currently seeking subspecialty reviewers for our Patient Education Resource Center (PERC). PERC provides fact sheets and discharge instructions for patients leaving the hospital or emergency room. These hand-outs fulfill the meaningful use requirements for the Medicare & Medicare Services Incentive Programs.

Click here to speak with us about becoming a peer reviewer.

DynaMed Careers

Looking for a change? The DynaMed editorial team is expanding and looking for talented and driven individuals. Visit the links below to learn about these exciting opportunities.

Deputy Editor of Cardiology
Deputy Editor of Oncology
Medical Writer
Medical Editor
Associate Editor