[Promising efficacy of the sirolimus-eluting stent in patients with acute myocardial infarction].
OBJECTIVE
This study investigated the safety and efficacy of sirolimus-eluting stents (SESs) on early and late outcomes in patients with acute myocardial infarction.


METHODS
A series of 100 consecutive patients (September 2004 to November 2005)with acute myocardial infarction undergoing primary stenting using SES ptember 24 hr) was compared with 100 consecutive patients (September 2003 to August 2004) treated with bare metal stent (BMS). The frequency of major adverse cardiac events (MACE) and stent thrombosis, and status of ticlopidine administration were assessed at 270 days.


RESULTS
The rates of premature discontinuation of ticlopidine (SES group <3 months: 11%, BMS group <1 month: 11%, p = NS) and stent thrombosis (SES group: 1%, BMS group: 0%, p = NS) were similar in the two groups. At follow-up, restenosis rate and target vessel revascularization rate were lower in the SES group(4% vs 19%, p < 0.001 and 4% vs 10%, p = 0.149, respectively). Furthermore, the occurrence of MACE at 270 days was significantly less frequent in the SES group compared with the BMS group (6% vs. 17%, p = 0.038). Multivariate analysis showed SES use tended to predict 270-day MACE (hazard ratio 0.37, 95% confidence interval 0.14-1.02, p = 0.055). Culprit lesion located in the left main trunk was identified as an independent predictor of 270-day MACE (hazard ratio 5.43, 95% confidence interval 1.07-27.59, p = 0.041).


CONCLUSIONS
The use of a SES was not associated with increased risk of stent thrombosis compared with a BMS. With lower rates of restenosis and subsequent target vessel revascularization, SES placement could provide superior outcomes in patients with acute myocardial infarction.
Gochi
Tomoko
T
Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Aichi. gtomoko0922@yahoo.co.jp
Umeda
Hisashi
H
Yoshida
Naoki
N
Maekawa
Hironobu
H
Watanabe
Kosuke
K
Okada
Taro
T
Katoh
Toshiaki
T
Asai
Toru
T
Tani
Tomomitsu
T
Yokoya
Masaki
M
Murakami
Yoshimasa
Y
Matsushita
Toyoaki
T
Shimizu
Takeshi
T
Ozaki
Yukio
Y
Hiramitsu
Shinya
S
Murohara
Toyoaki
T
Nomura
Masanori
M
Morimoto
Shinichiro
S
Hishida
Hitoshi
H
D000368:Aged; D023903:Coronary Restenosis / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents / Q000009:adverse effects; D013988:Ticlopidine / Q000008:administration & dosage; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D013988:Ticlopidine; D020123:Sirolimus