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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.

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