Two new studies published on July 16 in JACC: Cardiovascular Interventions provide closer looks at the use of drug eluting stents (DES). Although DES are widely used due to their dramatic antirestenosis efficacy, continued research is key to knowing when to use them most appropriately and effectively in patients.
The first study used the DELTA Registry to compare major adverse cardiac and cerebrovascular events (MACCE) after percutaneous coronary intervention (PCI) with first generation DES vs. coronary artery bypass grafting (CABG) in patients with unprotected left main coronary artery disease (ULMCA). In this study, no difference between PCI and CABG was observed in the occurrence of death, cerebrovascular accidents, and MI.
Study authors did note, however, that rates of repeat revascularization were still higher among patients who underwent PCI than among those who underwent CABG – a clear advantage. That being said, the authors suggest that in "selected cases and in highly competent tertiary centers, PCI for ULMCA disease can be considered a safe and effective procedure, with encouraging results at long-term follow-up, and might possibly be considered a feasible alternative to CABG."
In the second study – called the RIBS-III (Restenosis Intra-Stent: Balloon Angioplasty Versus Drug-Eluting Stent) study – patients with DES ISR saw superior late clinical and angiographic results with the implantation of a different DES, than those undergoing alternative interventions. The study looked at 363 consecutive patients with DES ISR from 12 Spanish sites. The different- DES strategy was used in 274 patients (75 percent) and alternative therapeutic modalities (no switch) in 89 patients (25 percent).
According to the study authors, RIBS-III is the first large, multi-center study to evaluate implantation of a different DES in this patient group. They also note that the study results "represent the longest clinical and angiographic follow-up currently available of the different-DES strategy."
"This experience underscores the value of investigating real-world methods of hemostasis via analysis of data collected in observational registries such as those within the NCDR," note the authors.