Sirolimus-eluting stent implantation in ST-elevation acute myocardial infarction: a clinical and angiographic study.
BACKGROUND
Sirolimus-eluting stents (SES) have recently been proven to reduce restenosis and reintervention compared with bare stents. Safety and effectiveness of SES in acute myocardial infarction remain unknown.


RESULTS
Since April 16, 2002, a policy of routine SES implantation has been instituted in our hospital, with no clinical or anatomic restrictions, as part of the RESEARCH (Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital) registry. During 6 months of enrollment, 96 patients with ST-elevation acute myocardial infarction underwent percutaneous recanalization and SES implantation; these patients comprise the study population. The incidence of major adverse cardiac events (death, nonfatal myocardial infarction, reintervention) was evaluated. Six-month angiographic follow-up was scheduled per protocol. At baseline, diabetes mellitus was present in 12.5% and multivessel disease in 46.9%. Primary angioplasty was performed in 89 patients (92.7%). Infarct location was anterior in 41 (42.7%) of the cases, and 12 patients (12.5%) had cardiogenic shock. Postprocedural TIMI-3 flow was achieved in 93.3% of the cases. In-hospital mortality was 6.2%. One patient (1.1%) had reinfarction and target lesion reintervention the first day as a result of distal dissection and acute vessel occlusion. During follow-up (mean follow-up of 218+/-75 days), 1 patient died (1.1%), no patient had recurrent myocardial infarction, and there were no additional reinterventions. No early or late stent thromboses were documented. At angiographic follow-up (70%), late loss was -0.04+/-0.25, and no patient presented angiographic restenosis.


CONCLUSIONS
In this study, sirolimus-eluting stent implantation for patients with ST-elevation acute myocardial infarction was safe without documented angiographic restenosis at 6 months.
Saia
Francesco
F
Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
Lemos
Pedro A
PA
Lee
Chi-Hang
CH
Arampatzis
Chourmouzios A
CA
Hoye
Angela
A
Degertekin
Muzaffer
M
Tanabe
Kengo
K
Sianos
Georgios
G
Smits
Pieter C
PC
McFadden
Eugene
E
Hofma
Sjoerd H
SH
van der Giessen
Willem J
WJ
de Feyter
Pim J
PJ
van Domburg
Ron T
RT
Serruys
Patrick W
PW
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000517:prevention & control; D004343:Drug Implants / Q000008:administration & dosage / Q000009:adverse effects; D004562:Electrocardiography; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D020123:Sirolimus / Q000008:administration & dosage* / Q000009:adverse effects; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome
D004343:Drug Implants; D007166:Immunosuppressive Agents; D020123:Sirolimus