An insight into the current use of drug eluting stents in acute and elective percutaneous coronary interventions in Europe. A report on the EuroPCI Survey

Abstract

To assess the use of drug eluting stents (DES) and passive stents in patients undergoing percutaneous coronary interventions (PCI) in Europe. We looked at the characteristics, procedural details and immediate outcome of 9,380 patients consisting of 2,471 STEMI patients (26.3%), 1,752 patients with NSTEMI-ACS (18.7%), and 5,157 elective patients (55.0%) in the European Heart Survey. The hybrid population of DES and passive stented patients (506 patients), and those treated without a stent, were excluded from the direct comparison between the two stented subgroup. These patients were, however, included in the total treated PCI population consisting of 10,982 patients. Patients presenting with stable angina or NSTEMI-ACS were more often treated with DES than patients with STEMI, which was in accordance with the current European Society of Cardiology (ESC) guidelines. There was no excess of acute stent thrombosis in the DES treated patients in any clinical setting including STEMI. Periprocedural complications were less in STEMI patients treated with DES compared to passive stents (BMS or coated stents). More complicated lesions and off-label use was observed with DES than passive stents. The overall in-hospital mortality was low (1.8%) and was better in the DES (1.2%) than passive stented patients (2.1%). In-hospital MACCE for the total PCI population (N=10,982) reflected the clinical presentation as it increased from electives (1.4%), NSTEMI-ACS (6.4%) to STEMI (7.8%) patients. There is marked variability in DES use across Europe. More detailed studies are needed to address the outcome of DES, especially in STEMI patients and the off-label use in order to contemplate a revision of the current ESC guidelines.