The largest randomized trial in history found no difference in the primary endpoint of death and nonfatal infarction between current conventional stents and drug-eluting stents at over 5 years in patients with stable or unstable coronary disease. As expected, NORSTENT did find a difference in revascularization rates between both groups.
This study presented at the European Society of Cardiology Congress was published simultaneously in the New England Journal of Medicine (NEJM) and randomized 9013 patients with stable or unstable coronary disease to undergo an angioplasty receiving either a contemporary drug-eluting stent (DES) or a contemporary conventional bare metal stent (BMS). Notably, 95% of the DES used were everolimus- or zotarolimus-eluting stents. Dual antiplatelet therapy was used for at least 9 months in both trial arms.
After 6 years of follow-up, primary endpoint events occurred as follows:
- In 16.6% of patients receiving DES.
- In 17.1% of patients receiving BMS
(p = 0.66).
No differences were observed after separately comparing the components of the primary outcome.
Unsurprisingly, repeat revascularization was more frequent in the BMS group (19.8% vs. 16.5%; p < 0.001). Definite thrombosis tended to be more frequent in the BMS group compared to the DES group (1.2% vs. 0.8%, respectively; p = 0.0498).
Original title: Drug-eluting or bare-metal stents for coronary artery disease.
Presenter: Kaare Harald Bonaa.
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