Clinical effectiveness of the drug-eluting stent in Uruguay

Ano de publicação: 2007

Objective:

To assess long-term results of DES and compare them with bare-metal stent (BMS) in patients with PCI in Uruguay.

Methods:

A national registry of PCI was established at the NRF. A historic-cohort of patients undergoing PCI between January 1st 2003 and December 31st 2007 were studied. The end point at vessel-treated level was free-survival of target vessel revascularization (TVR). At patient level we assessed overall survival, and free-survival of a composite event (CE) of death or TVR. The propensity-score (PS) method was used for risk adjustmen (2). We perform one to one matched analysis on the basis of the estimated PS of each treated vessel and patient. Using the probability of the PS, we first randomly selected a case trated with DES and then matched that case with a control treated with BMS with the closest probability at the PS. A survival analysis thorough stratified Cox model was performed. A sensitivity analysis according to diference in mortality between both cohorts at day 5 was used to correct the residual confounding for patients survival (3).

Results:

In this period 11067 patients (16166 vessels) were treated (BMS in 8650, DES in 1458 and both in 959 patients).

Conclusions:

DES were efective in Left Anterior Descending Artery but not for other vessels. DES were associated with greater overall survival and CE free survival in patients with indication strongly adjusted to the clinical practice that was conducted in Uruguay. Once the bias was corrected, the potential benefit of DES on mortality was not confirmed. Sensitivity analysis and bias correction is highly recommended for adequate interpretation of observational studies. (AU)

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