Drug-Eluting Stents Reduce Need for Revascularization after PCI

MedicalResearch.com Interview with:
Dr. Kaare Harald Bønaa

Principal investigator
University of Tromsø, Norway

MedicalResearch.com: What is the background for this study?

Response: The NORSTENT study was designed shortly after the “Barcelona fire storm” in 2006 that raised severe safety concerns against drug-eluting stents (DES). At that time there was evidence for increased risk of stent thrombosis with DES. How this could influence long term results compared to PCI with bare metal stents (MMS) was not known.

Accordingly, we designed the NORSTENT study with the primary composite endpoint of all-cause mortality and non-fatal spontaneous myocardial infarction at a medial of 5 years of follow-up.

MedicalResearch.com: What are the main findings?

Response: The NORSTENT study demonstrates that contemporary DES or BMS confer no difference in the rates of all-cause mortality or nonfatal myocardial infarction during 6 years of follow-up.

Repeat revascularizations were significantly reduced in the DES group, demonstrating the durability of this well-known effect over 6 years in a close to all-comers study.
An important finding is also that the rate of stent thrombosis was low with both stent types and numerically lower in the DES group with a borderline statistically significant difference.

Type of stent had no impact on quality of life as assessed by the Seattle Angina Questionnaire.

MedicalResearch.com: What should readers take away from your report?

Response: The take home message from the NORSTENT study is that patients do not live longer nor better with a drug-eluting compared to a metal stent.

However, with DES the need for repeat revascularization is reduced and our study contributes to the growing evidence that contemporary DES have a lower risk of stent thrombosis than BMS. All over, the drug-eluting stents perform best, but the difference between DES and BMS was less than expected.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: The risk for stent thrombosis with DES compared to BMS is still an unresolved issue. It is reassuring that the risk for stent thrombosis seems to be low with both stent types and maybe even lower with DES compared to BMS. If this is true we have a paradigm shift in PCI. However, the potential mechanisms for reduced risk of stent thrombosis with DES are not known and we do not know whether this holds for all types of contemporary DES.

This is an area that needs further research.

MedicalResearch.com: Is there anything else you would like to add?

Response: The NORSTENT study was possible due to a huge concerted effort from 105 investigators at the PCI centers in Norway.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.


Drug-Eluting or Bare-Metal Stents for Coronary Artery Disease

Kaare H. Bønaa, M.D., Ph.D., Jan Mannsverk, M.D., Rune Wiseth, M.D., Ph.D., Lars Aaberge, M.D., Ph.D., Yngvar Myreng, M.D., Ph.D., Ottar Nygård, M.D., Ph.D., Dennis W. Nilsen, M.D., Ph.D., Nils-Einar Kløw, M.D., Ph.D., Michael Uchto, M.D., Thor Trovik, M.D., Ph.D., Bjørn Bendz, M.D., Ph.D., Sindre Stavnes, M.D., Reidar Bjørnerheim, M.D., Ph.D., Alf-Inge Larsen, M.D., Ph.D., Morten Slette, M.D., Terje Steigen, M.D., Ph.D., Ole J. Jakobsen, M.D., Øyvind Bleie, M.D., Ph.D., Eigil Fossum, M.D., Ph.D., Tove A. Hanssen, R.N., Ph.D., Øystein Dahl-Eriksen, M.D., Inger Njølstad, M.D., Ph.D., Knut Rasmussen, M.D., Ph.D., Tom Wilsgaard, Ph.D., and Jan E. Nordrehaug, M.D., Ph.D., for the NORSTENT Investigators*

August 30, 2016 DOI: 10.1056/NEJMoa1607991

NEJM and ESC 2016

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Last Updated on August 31, 2016 by Marie Benz MD FAAD