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Comparison of drug-eluting stents to bare-metal stents in ST-elevation myocardial infarction in long-term follow-up.

Abstract：

BACKGROUND:Recent data from "real world" registries and some randomised trials concerning the safety and efficacy of drug-eluting stents (DES) in patients with acute ST-elevation myocardial infarction (STEMI) are equivocal. AIM:We sought to compare DES with bare-metal stents (BMS) in STEMI patients treated with primary percutaneous coronary intervention in terms of safety and efficacy parameters in long-term follow-up. METHODS:895 consecutive STEMI patients admitted between 2003 and 2006 were included in this observational study. The clinical and procedural characteristic as well as long-term outcome of 327 patients treated with DES were compared with 568 patients treated with BMS. Combined primary endpoint consisted of: death, myocardial infarction (MI) and target vessel revascularisation (TVR). RESULTS:Age, sex, risk factors, presence of 3-vessel disease, left ventricular ejection fraction and the use of IIb/IIIa antagonist were comparable in both groups. During a mean follow-up of 570 ± 490 days, the mortality rate was 8.9% in the DES group vs. 15.5% in the BMS group (p = 0.005). In the DES group, lower incidences of both death and MI (9.5% vs. 16%, p = 0.006) as well as the combined endpoint of death, MI and TVR (19.3% vs. 31.3%, p < 0.001) were recorded. Target lesion revascularisation was more frequently performed in the BMS group (13.4% vs. 8.6%, p = 0.03). However, patients who received BMS more frequently had history of MI and coronary interventions, Killip class > 1 on admission, lower level of haemoglobin and HDL-cholesterol and higher level of troponin than those who received DES. After adjustment, the use of BMS was no longer significantly associated with worse clinical outcome with a trend in favour of DES. The only independent factor associated with increased risk of the combined endpoint was the Killip class > 1 (p = 0.003). CONCLUSIONS:In STEMI patients, DES are not inferior in comparison to BMS in terms of safety and efficacy parameters and seem to be associated with a lower rate of target lesion revascularisations. Additionally, Killip classification remains a simple and important classification used to stratify risk in patients with acute MI.

journal_name

Kardiol Pol

journal_title

Kardiologia polska

authors

Kübler P,Jankowska EA,Ferenc M,Ponikowski P,Banasiak W,Reczuch K

subject

Has Abstract

pub_date

2013-01-01 00:00:00

pages

25-31

issue

eissn

0022-9032

issn

1897-4279

pii

VM/OJS/KP/7608

journal_volume

pub_type

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Comparison of drug-eluting stents to bare-metal stents in ST-elevation myocardial infarction in long-term follow-up.