Long-term outcome of acute myocardial infarction patients treated with stents versus balloon angioplasty: results from randomized trials.
OBJECTIVE
To examine the impact of primary stent implantation versus balloon angioplasty on long-term outcome (median 8 years) in 117 patients with ST-elevation myocardial infarction (STEMI) from randomized trials.


METHODS
Enrolled patients were those presenting with STEMI within 12 h of symptom onset. Patients were randomized to either Palmaz-Schatz stent implantation (N=25) or balloon angioplasty (N=23) between January and November 1996; or Palmaz-Schatz (N=26), or Cordis coil stent implantation (N=24) or balloon angioplasty (N=19) between February 1998 and March 1999.


RESULTS
Patients (67+/-11 years) arrived to the hospital within median 2.5 h of symptom onset with Killip 1/2/3/4 grade (72/19/7/2%, respectively). The culprit lesion was located in the left anterior descending (50%), right (39%), or left circumflex coronary artery (11%) with TIMI 0/1/2/3 flow (81/5/12/2%, respectively). Clinical/angiographic features were comparable between the 2 groups. During follow-up, there was a significant reduction in cardiac mortality in the stent group (5%) compared to the angioplasty group (17%, log-rank test p=0.04). In addition, the stent group had a lower target lesion revascularization rate (28% versus 52%, p=0.008), and a significantly lower major adverse cardiac event rate (37% versus 67%, p=0.005), than the angioplasty group.


CONCLUSIONS
Compared to balloon angioplasty, primary stenting resulted in a sustained beneficial effect on cardiac mortality at 8 years.
Kaneda
Hideaki
H
Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, 1202-1 Yamazaki, Kamakura 247-8533, Japan. hdkaneda@gmail.com
Hiroe
Yoshitaka
Y
Tanaka
Shinji
S
Shiono
Takaaki
T
Inaba
Hideko
H
Miyashita
Yusuke
Y
Takahashi
Saeko
S
Taketani
Yoshio
Y
Domae
Hiroshi
H
Matsumi
Junya
J
Saito
Shigeru
S
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome