Drug Coated Stents Better After Heart Attack

Drug-coated stents are more effective than the bare metal kind for people who have heart attacks, a new study finds.

The death rate, incidence of second heart attacks, and need for new artery-opening procedures were lower for those getting drug-coated stents, said a report in the Sept. 25 issue of the New England Journal of Medicine on more than 7,000 people treated for heart attacks in Massachusetts in 2003 and 2004.

“We were looking to see if there was a risk, and we actually saw there was a benefit,” said study author Dr. Laura Mauri, an assistant professor of medicine at Harvard Medical School and an interventional cardiologist at Brigham and Women’s Hospital.

In the two years after stents were implanted in arteries reopened after a heart attack, 8.5% of the 4,016 recipients of drug-coated stents died, compared to 11.6% of the 3,201 recipients of bare-metal stents. Second heart attacks struck 7.4% of coated stent recipients and 8.5% of those getting bare-metal stents. And new artery-opening procedures were required for 10.7% of the coated stent recipients, compared to 14.9% of those getting bare-metal stents.

The results are close to those reported in May by a group led by Dr. Peter W. Groeneveld, an assistant professor of medicine at the University of Pennsylvania, who analyzed Medicare data on 72,000 stent recipients.

“Our population was slightly different from theirs,” Groeneveld said. “We used both patients who had heart attacks and didn’t, but the relative difference in rates of death and heart attacks after the procedures seems to be what we found.”

The new study “is very important, because it is a large study with long-term follow-up,” Mauri said.

“The strength of this study is that these guys have more detailed clinical information on the patients than we did,” Groeneveld said. “The results are very similar. We think we are looking at the same thing.”

There has been a general shift toward use of coated stents among the mass of patients having the artery-opening procedure called angioplasty, Groeneveld said. Coated stents were approved by the  FDA in 2003, and the two stents studied were done “in a period of time when the cardiology community was transitioning over to drug-eluting stents, a process of adopting new technology,” he said.

Overall, “about two-thirds to three quarters of patients now get drug-eluting stents,” Groeneveld said.

But that change doesn’t necessarily apply to cases where stents are implanted because of a heart attack, Mauri said. “Acute myocardial infarction [heart attack] is one setting where physicians are still concerned about safety, so we are still close to 50-50,” she said. “Where the patient is stable, the percentage of drug-eluding stents is much higher.”

One important reason why a bare-metal stent is implanted after a heart attack is fear that the recipient might not follow advice to take the clot-preventing drug clopidogrel, Mauri said. “If they can’t take clopidogrel long-term, there may be a higher risk of thrombosis [blockage],” she said.

And bare-metal stents can be appropriate for many people who require angioplasty, Groeneveld said. “There are patients who benefit from bare-metal stents,” he said. “Sometimes, they are the right choice because of the location of the blockage, the size of the blood vessel, and the potential complications that can occur with drug-eluting stents.”

While drug-coated stents do better on average, “that does not mean that every single individual should get a drug-eluting stent rather than a bare-metal stent,” Groeneveld said. “Our job is to figure out which patient should get which.”