A Study to Compare Major Adverse Cardiac Event in Patient Undergoing PCI with Drug Eluting Stents Vs Bare Metal Stents

This study compared Major Adverse Cardiac Event in patient with Acute Coronary Syndromes undergoing PCI with Drug Eluting Stents Vs Bare Metal Stents. A retrospective, observational study was carried out in an inpatient setting of the private tertiary care hospital. Patients with >18 years, diagnosed for Acute Coronary Syndromes (ACS), required intervention in coronary artery with implantation of Drug Eluting Stents (DES) or Bare Metal Stents (BMS) were recruited in the study. The data had been collected from file or database of the hospital. All subjects were followed for major adverse cardiac event. Result. A total of 202 patients who underwent percutaneous coronary intervention (PCI) were enrolled into DES group (N=101) and BMS group (N=101). All patients were followed up at 1 month, 3 months, 6 months & 12 months for Major Adverse Cardiac Events (MACE). Clinical outcomes during 12 months were compared between DES group & BMS group. There was no significant difference in baseline parameters including demographic, risk factors of ACS, diagnosis, angiographic parameters between both groups. Overall MACE rates were reported non-significantly high in BMS group patients (14.85%) compare to DES group patients (8.91%) (P=0.458). However, DES group had lower rates of death (0.99% vs 1.98%, P=0.57), rate of MI (3.96% vs 4.95% P=0.73), rate of revascularization (1.98% vs 3.96% p=0.42) & rate of sub acute thrombosis (1.98% vs 3.96% P=0.42) and higher rate of bleeding (1.98% vs 0.99% p=0.57) compare to cohort-II. Conclusion. The use of DES in the setting of Acute Coronary Syndrome is associated with lower Major Adverse Cardiac Event (MACE) rate compared to BMS without compromising the overall safety over the course of one-year follow-up. The long-term safety of drug-eluting stents needs to be ascertained in large, randomized trials.


INTRODUCTION
Cardiovascular disease (CVD) is the leading cause of death and disability in the world. [1] Among these, coronary artery disease (CAD) is the most prevalent manifestation and is associated with high mortality and morbidity. India has the highest burden of acute coronary syndromes in the world, yet little is known about the treatments and outcomes of these diseases. There will be required to document the characteristics, treatments, and outcomes of patients with acute coronary syndromes who were admitted to hospitals in India. [2] Prospective, randomized clinical trials have shown that in-stent restenosis is reduced by the use of drug-eluting stents, as compared with bare-metal stents. However, the use of drug-eluting stents has rapidly 56 been expanded to all types of patients, including those with more complicated coronary lesions and in acute settings. Recently metaanalyses of randomized trials [3][4] and registries [5] have raised concern about incomplete neointimal coverage with a subsequent increase in late stent thromboses in patients with drugeluting stents. [6][7] One randomized trial indicated that the implantation of drug-eluting stents was associated with an early reduction in death and myocardial infarction -an improvement that was lost during the subsequent 6 to 18 months by a late increase in the same events. [8] We determined that the evaluation of large clinical registries might provide useful information concerning the long-term efficacy and safety of drug-eluting stents. Therefore, we evaluated the long-term outcome in all patients who underwent stent implantation.

RESEARCH METHOD
A retrospective, open label, observational study carried out in an inpatient setting of the private tertiary care hospital. Patients with >18 years, diagnosed for Acute Coronary Syndromes (ACS), required intervention in coronary artery with implantation of Drug Eluting Stents (DES) or Bare Metal Stents (BMS) were recruited in the study. The data had been collected from file or database of the hospital. All subjects were followed for major adverse cardiac event (MACE) including death, Myocardial infarction, Urgent revascularization, sub acute thrombosis & bleeding at 1 month, 3 months, 6 months & 12 months after PCI. All collected data was analyzed in its group for clinical outcomes. All variables were analyzed using percentage, mean & standard deviation. Statistical difference between both cohorts was calculated by applying independent t-test & odds ratio.

RESULTS & ANALYSIS
There were 202 patients who underwent PCI between December 2008 and July 2009 was enrolled in retrospective, observational study. All these subjects were divided in two Cohorts.
Safety and efficacy study result demonstrated that over all MACE and mortality rate appears lower in DES group compare to BMS group. However, it was not significant statistically. Further long term study is required to get more viable results with larger population.

IJPHS
A study to compare M

CONCLUSION
Our study compared the cohort patients treated with coro complete. There was a trend tow event rate thereafter. The likeliho demonstration of incomplete neo with drug-eluting stents. Safety a appears lower in DES group com long term study is required to get 2252-8806 e Major Adverse Cardiac Event in patient undergoing PC the clinical outcome of drug-eluting stents versus bare oronary stents at Private tertiary care hospital. The lon oward a lower event rate during the initial 6 months an ihood that these events were caused by stent thrombosis eointimal coverage as a probable reason for late stent y and efficacy study result demonstrated that over all MA compare to BMS group. However, it was not significan get more viable results with larger population.
PCI … (Chetan R. Patel) 59 re-metal stents in a large long-term follow-up was and a consistently higher sis is strengthened by the nt thromboses in patients MACE and mortality rate cant statistically. Further ISSN: 2252-8806