Drug-eluting versus bare metal stents in patients with st-segment-elevation myocardial infarction: eight-month follow-up in the Drug Elution and Distal Protection in Acute Myocardial Infarction (DEDICATION) trial.
BACKGROUND
Implantation of drug-eluting stents (DES) limits the rate of coronary restenosis in most patients with coronary artery disease, but data are scarce with regard to their use in patients with ST-segment-elevation myocardial infarction and in connection with distal protection of the microvascular perfusion during primary percutaneous coronary intervention.


RESULTS
We randomly assigned 626 patients referred within 12 hours from symptom onset of an ST-elevation myocardial infarction to have a DES or a bare metal stent implanted in the infarct-related lesion with or without distal protection during primary percutaneous coronary intervention. Quantitative coronary angiography was performed during the index treatment and 8 months later. The primary end point was loss of the lumen diameter in the infarct-related lesion induced by neointimal proliferation. Patients were comparable with regard to baseline demographic and angiographic characteristics. The mean late lumen loss was significantly lower in patients treated with a DES (0.06 mm; SD, 0.66 mm) than in patients who had a bare metal stent implanted (0.47 mm; SD, 0.69 mm; P<0.001). The rate of the composite end point of cardiac death, recurrent myocardial infarction, and target lesion revascularization was 8.6% in the DES group versus 14.4% in the bare metal stent group (P=0.03). Cardiac death occurred in 4.2% and 1.6% of the patients (P=0.09) and stent thrombosis occurred in 2.0% and 2.6% (P=0.72), respectively.


CONCLUSIONS
Implantation of DES improves the angiographic outcome and need for repeat revascularization without increasing the short-term risk of stent thrombosis but has a tendency to increase cardiac death in patients with ST-segment-elevation myocardial infarction.
Kelbaek
Henning
H
Cardiac Catheterization Laboratory 2013, Rigshospitalet, 9 Blegdamsvej, DK-2100 Copenhagen Ø, Denmark. henning.kelbaek@rh.regionh.dk
Thuesen
Leif
L
Helqvist
Steffen
S
Clemmensen
Peter
P
Kløvgaard
Lene
L
Kaltoft
Anne
A
Andersen
Bente
B
Thuesen
Helle
H
Engstrøm
Thomas
T
Bøtker
Hans E
HE
Saunamäki
Kari
K
Krusell
Lars R
LR
Jørgensen
Erik
E
Hansen
Hans-Henrik T
HH
Christiansen
Evald H
EH
Ravkilde
Jan
J
Køber
Lars
L
Kofoed
Klaus F
KF
Terkelsen
Christian J
CJ
Lassen
Jens F
JF
D015906:Angioplasty, Balloon, Coronary; D049109:Cell Proliferation; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D023921:Coronary Stenosis; D003643:Death; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000592:standards*; D005500:Follow-Up Studies; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000628:therapy*; D015607:Stents / Q000009:adverse effects / Q000592:standards*; D013927:Thrombosis / Q000209:etiology; D016896:Treatment Outcome; D017539:Tunica Intima