Gender Data Forum: Are DES Safer and More Effective Than Bare Metal Stents in Women?

The use of drug-eluting stents (DES) in women is more effective and safe than using bare-metal stents during long-term follow-up, according to a study released on Sept. 2 during the ESC Congress 2013 and simultaneously published in The Lancet.

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The study, which pooled patient-level data from 43,904 female participants from 26 randomized trials of DES, analyzed outcomes according to stent type (bare-metal stents, early-generation DES, and newer-generation DES). According to the data, the estimated cumulative incidence of the composite of death or myocardial infarction at three years occurred in 12.8 percent of women in the bare-metal stent group, 10.9 percent in the early-generation DES group, and 9.2 percent in the newer-generation DES group (p=0·001).

In that same period, definite or probable stent thrombosis occurred in 1.3 percent, 2.1 percent and 1.1 percent of women in the bare-metal stent, early-generation DES, and newer-generation DES groups, respectively (p=0·01). The study investigators also noted that the use of DES was associated with a significant reduction in the three-year rates of target lesion revascularization.

Overall, the study authors point out that the use of newer-generation DES was associated with "significantly lower rates" of death or myocardial infarction, definite or probable stent thrombosis, and definite stent thrombosis than was the use of early- generation DES. "This analysis shows for the first time, to the best of our knowledge, that the improved outcome in women in terms of safety with newer-generation DES did not compromise but rather improved efficacy," they said. As a result, they suggest that newer-generation DES be considered the standard of care for percutaneous coronary revascularization in women.

Keywords: Incidence, Myocardial Infarction, Follow-Up Studies, Thrombosis, Drug-Eluting Stents, Standard of Care, Percutaneous Coronary Intervention

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