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BMJ 2009; 338 doi: (Published 12 May 2009) Cite this as: BMJ 2009;338:b1895

Drug eluting stents seem safe in the medium to long term

Continuing uncertainty about the long term safety of drug eluting stents led Swedish researchers to take a close look at what happened to Swedish adults who received any kind of stent between 2003 and 2006. The drug eluting option seemed safe in analyses with up to five years of follow-up. The researchers found no extra deaths (relative risk 0.94, 95% CI 0.85 to 1.05) and no extra heart attacks (0.97, 0.88 to 1.06) in patients who had drug eluting stents compared with those who had bare metal stents. Drug eluting stents were associated with a lower risk of restenosis (0.43, 0.36 to 0.52) that was most marked in patients with the worst lesions.

The main analysis was confined to the 28 953 adults who had just one stent during index percutaneous coronary intervention. The findings were similar when the analysis was extended to all adults who received one or more stents (n=47 967). All analyses were carefully adjusted for clinical and demographic differences between adults receiving drug eluting stents and those receiving bare metal stents.

This study extends an earlier report examining the same national register that hinted at greater long term mortality with drug eluting stents than with bare metal stents. The new study—which includes more data and a longer follow-up—seems reassuring, say the researchers.

In a separate randomised trial published in the same issue of New England Journal of Medicine (pp 1946-59), drug eluting stents also seemed safe for 3006 people with acute myocardial infarction. Those individuals given a paclitaxel eluting stent had no more adverse cardiovascular events over one year than did controls given a bare metal stent (8.1% v 8.0%; hazard ratio 1.02, 95% CI 0.76 to 1.36). The combined safety end point included death, reinfarction, stroke, and stent thrombosis. People given a paclitaxel eluting stent needed significantly …

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