DES vs BMS

Recent registry data

 Western Denmark
Clinical endpoints to 2 years (unadjusted)

DES ( N=8847)
BMS (N=3548)
14
12
P=0.004 P<0.0001
% of event

10
7.9 7.9
8 6.4
6 NS 5.3
4.5
3.7
4
NS
2 0.6 0.8
0
Death MI TLR Total ST

Jensen TCT 2007

 Western Denmark
Clinical endpoints >1 to 2 years

DES ( N=8847)
BMS (N=3548)
14
12
P<0.0001
% of event

10
7.90
8
6 5.3
P=0.02 P<0.001
4 2.4 2.20 2.0 P=0.0019
2 1.00
0.2 0.04
0
Death MI TLR* Definite ST
Adjusted P values *2 yr cumulative

Jensen TCT 2007

Jensen TCT 2007
Jensen TCT 2007
 Ontario Registry
Clinical endpoints to 2 years in propensity matched
cohort
DES ( N=3751)
BMS (N=3751)
14
P<0.001 P=0.02
12 10.7 10.5
9.3
% of event

10
P=0.001 P=0.95 7.4
8
6.1 5.7
6 5.2
4.3
4
2
0
Death MI TVR Death/MI

Tu et al. N Engl J Med 2007;357:1393-1402.

 Ontario Registry
Clinical endpoints > 1 to 2 years in propensity
matched cohort
DES ( N=3751)
4 BMS (N=3751)

3.2
3.0
% of event

2.1 2.2 2.1

1.9
2 1.6
1.3

0
Death MI TVR Death/MI
P values not available
Tu et al N Engl J Med 2007;357:1393-1402.
 Author conclusion

DES are more effective than BMS in reducing

target-vessel revascularization (TVR) in patients
at highest risk for restenosis, but offer minimal
benefit in patients at lowest risk.

Tu JV et al N Engl J Med 2007;357:1393-1402.

Mauri AHA 2007
Mauri AHA 2007
Mauri AHA 2007
Mauri AHA 2007
 Long term outcome with
drug eluting stents vs
bare metal stents in Sweden
– one additional year of follow-up

Stefan James, Jörg Carlsson, Johan Lindbäck, Tage

Nilsson, Ulf Stenestrand, Lars Wallentin and Bo
Lagerqvist for the SCAAR study group

None of the authors have any conflicts of interest in relation to the

presentation
 Restenosis
one stent cohort
Unadjusted
2004-2005, Crude Adjusted
2004-2005, Adjusted

0.10
0.10

BMS BMS
DES DES

Cumulative risk of restenosis

Cumulative risk of restenosis

0.08
0.08

0.06
0.06

0.04
0.04

0.02
0.02

0.00
RR: 0.48 (0.39, 0.58)
0.00

0 1 2 3 4 0 1 2 3 4
Time (years) Time (years)
BMS 9217 8615 8399 7147 5205 3057 887 0 0 BMS 8235 7708 7505 6326 4602 2668 753 0 0
DES 6229 5967 5822 4429 2738 1334 317 0 0 DES 5438 5223 5097 3809 2294 1110 257 0 0

James ESC 2007

 Adjusted death /MI

Total cohort One stent cohort

N = 35 262
2003-2005, Adjusted N = 18 937
2003-2005, Adjusted

0.25
0.25

BMS BMS
DES DES

Cumulative risk of death or MI

Cumulative risk of death or MI

0.20
0.20

0.15
0.15

0.10
0.10

0.05
0.05

0.00
RR: 0.91 (0.82, 1.01)
0.00

RR: 1.01 (0.94, 1.09)

0 1 2 3 4 0 1 2 3 4
Time (years) Time (years)
BMS 18769 17326 16957 14414 11596 8755 5523 2934 7 BMS 12556 11701 11453 9731 7799 5878 3739 1977 7
DES 12015 11286 11003 7648 4956 3062 1498 535 0 DES 6381 6017 5875 4103 2644 1631 798 295 0

James ESC 2007

 Death/MI-total cohort
Year by year
2003
2003 landmark
2004
2004 landmark 2005
2005 landmark
0.25

0.25

0.25
BMS BMS BMS
DES DES DES
Cumulative risk of death or MI

Cumulative risk of death or MI

Cumulative risk of death or MI

0.20

0.20

0.20
0.15

0.15

0.15
RR: 1.06 (0.86, 1.32) RR: 0.98 (0.83, 1.17) RR: 0.69 (0.59, 0.81)
0.10

0.10

0.10
0.05

0.05

0.05
0.00

0.00

0.00
RR: 1.31 (1.12, 1.53) RR: 1.22 (1.05, 1.43) RR: 0.93 (0.76, 1.13)

0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
Time (years) Time (years) Time (years)
BMS 6448 6037 5918 5820 5713 5612 5520 2934 7 BMS 6737 6228 6090 5983 5883 3143 3 0 0 BMS 5584 5061 4949 2611 0 0 0 0 0
DES 1799 1685 1644 1607 1568 1539 1496 535 0 DES 3880 3638 3550 3468 3388 1523 2 0 0 DES 6336 5963 5809 2573 0 0 0 0 0

James ESC 2007

 Stent thrombosis
Unadjusted
Cumulative risk of stent thrombosis %

2
Stent type Total cohort
BMS n=20 058
DES n=21 717
N = 41 775 stents

0.5% per year

1

0 1 2
Time (years)

James ESC 2007

 SCAAR
UCR
Conclusions SWEDEN
2006

During 4 years follow-up the DES-group compared to

the BMS-group, with adjustment for differences in
available background characteristics, showed:
• no overall significant difference in mortality or MI
• a significantly lower event rate during the initial 6 months
• a significantly higher event rate after 6 months which is
compensated by the lower early event rate
• a relative reduction of restenosis by almost 50%
corresponding to an absolute reduction of 3.5%

James ESC 2007

DES vs BMS registries at TCT 07

P = 0.052 P < 0.0001

All cause mortality rate (%)

P < 0.001

P < 0.001 P = 0.004

P < 0.001
P = NR

N = 1359

N = 8847
N = 4061
N = 3160

N = 5719

N = 5399

N = 6384

N = 7834

N = 3751

N = 3751

N = 5996

N = 3548
N = 871
N = 483

BMS

DES
3-year 3-year 2-year 2-year 3-year 2-year 2-year
SJ Park Harjai Vagonescu Hannan Ko B Brodie Jensen