Predicting the Restenosis Benefit of Drug-Eluting Versus Bare Metal Stents in Percutaneous Coronary Intervention
Abstract
Background—: Drug-eluting stents (DES) for percutaneous coronary intervention decrease the risk of restenosis compared with bare metal stents. However, they are costlier, require prolonged dual antiplatelet therapy, and provide the most benefit in patients at highest risk for restenosis. To assist physicians in targeting DES use in patients at the highest risk for target vessel revascularization (TVR), we developed and validated a model to predict TVR. Methods and Results—: Preprocedural clinical and angiographic data from 27 107 percutaneous coronary intervention hospitalizations between October 1, 2004, and September 30, 2007, in Massachusetts were used to develop prediction models for TVR at 1 year. Models were developed from a two-thirds random sample and validated in the remaining third. The overall rate of TVR was 7.6% (6.7% with DES, 11% with bare metal stents). Significant predictors of TVR included prior percutaneous coronary intervention, emergency or salvage percutaneous coronary intervention, prior coronary bypass surgery, peripheral vascular disease, diabetes mellitus, and angiographic characteristics. The model was superior to a 3-variable model of diabetes mellitus, stent diameter, and stent length (c statistic, 0.66 versus 0.60; P <0.001) and was well calibrated. The predicted number needed to treat with DES to prevent 1 TVR compared with bare metal stents ranged from 6 (95% confidence interval, 5.4–7.6) to 80 (95% confidence interval, 62.7–116.3), depending on patients' clinical and angiographic factors. Conclusions—: A predictive model using commonly collected variables can identify patients who may derive the greatest benefit in TVR reduction from DES. Whether use of the model improves the safety and cost-effectiveness of DES use should be tested prospectively.
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Patients with type 2 diabetes have a higher risk of the full range of ischemic events than patients without type 2 diabetes.
“Although patients with T2DM are at increased risk for the full spectrum of ischemic events compared with those without T2DM, the issue of restenosis after PCI has been an area of particular concern in those with T2DM.289”
From Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association (2020) · cites this paper as [289]
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- depending on patient characteristics. Because the predicted benefit associated with drug-eluting stents varies broadly among patients, this predictive model may be used to support the optimal use of drug-eluting stents in a prospective fashion and to engage patients in the decision-making process before coronary intervention. Go to http://cme.ahajournals.org to take the CME quiz for this article.
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Li, F., Gu, Y., Tian, Y., Cheng, J., & Zhao, G. (2018) · International Conference on Biomedical Engineering and Technology (ICBET) · doi:10.1145/3208955.3208959 · Cited by 1 · see citing works
Periodontitis Is Associated With Risk of Conventional Stent Restenosis: Pilot Case-Control Study
Osugue, R. K., dos Santos, N. C. C., Araújo, C. F., de Almeida, F. X., Feres, M., & Santamaria, M. P. (2021) · Frontiers in Dental Medicine · doi:10.3389/fdmed.2021.673626 · Cited by 1 · see citing works
Peripheral Vascular Disease in Circulation and the Circulation Subspecialty Journals
Editors, T. (2012) · Circulation · doi:10.1161/circulationaha.112.108464 · Cited by 1 · see citing works
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Yong, A. S. C., & Tremmel, J. A. (2013) · Catheterization and Cardiovascular Interventions · doi:10.1002/ccd.24964 · Cited by 1 · see citing works
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Self-citationCan the restenosis benefit of drug-eluting and bare-metal stents be predicted?
Briguori, C. (2012) · Interventional Cardiology · doi:10.2217/ica.11.97
Rashid, S. (2016) · Journal of Cardiology & Cardiovascular Therapy · doi:10.19080/jocct.2016.01.555570
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Feres, F., Feres, I. C., & Botelho, R. (2012) · Revista Brasileira de Cardiologia Invasiva · doi:10.1590/s2179-83972012000100003
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Managing Stable Coronary Artery Disease in Diabetes
Koulouridis, I., & Johnstone, M. T. (2023) · Contemporary cardiology · doi:10.1007/978-3-031-13177-6_23
Li, G., Zhu, D., He, W., & Ouyang, S. (2025) · Heart & Lung · doi:10.1016/j.hrtlng.2025.10.013
- Authors
- Yeh, R. W., Normand, S.-L. T., Wolf, R. E., Jones, P. G., Ho, K. K. L., Cohen, D. J., Cutlip, D. E., Mauri, L., Kugelmass, A. D., Amin, A. P., & Spertus, J. A.
- Affiliations
- Brigham and Women's Hospital (US)
- ORCID
- Venue
- Circulation
- Published
- 2011-10-04
- Volume
- 124
- Issue
- 14
- Pages
- 1557-1564
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2151959401
- Cited by
- 63
- References
- 33
- Citations by year
- 2025: 1 · 2023: 4 · 2022: 1 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 3 · 2017: 2 · 2016: 11 · 2015: 2 · 2014: 9 · 2013: 9 · 2012: 14
- FWCI
- 10.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Keywords
- drug-eluting stents, bare-metal stents, percutaneous coronary intervention, target vessel revascularization, restenosis, prediction model, patient selection, diabetes mellitus, peripheral vascular disease, coronary artery disease, number needed to treat, cost-effectiveness
- MeSH terms
- Aged, Cost-Benefit Analysis, Female, Humans, Male, Massachusetts, Middle Aged, Models, Cardiovascular, Registries, Stents, Angioplasty, Balloon, Coronary, Coronary Angiography, Coronary Restenosis, Coronary Stenosis, Drug-Eluting Stents
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