title: Drug-eluting or bare-metal stents for acute myocardial infarction.
abstract: BACKGROUND
  Studies comparing percutaneous coronary intervention (PCI) with drug-eluting and bare-metal coronary stents in acute myocardial infarction have been limited in size and duration.
  
  
  METHODS
  We identified all adults undergoing PCI with stenting for acute myocardial infarction between April 1, 2003, and September 30, 2004, at any acute care, nonfederal hospital in Massachusetts with the use of a state-mandated database of PCI procedures. We performed propensity-score matching on three groups of patients: all patients with acute myocardial infarction, all those with acute myocardial infarction with ST-segment elevation, and all those with acute myocardial infarction without ST-segment elevation. Propensity-score analyses were based on clinical, procedural, hospital, and insurance information collected at the time of the index procedure. Differences in the risk of death between patients receiving drug-eluting stents and those receiving bare-metal stents were determined from vital-statistics records.
  
  
  RESULTS
  A total of 7217 patients were treated for acute myocardial infarction (4016 with drug-eluting stents and 3201 with bare-metal stents). According to analysis of matched pairs, the 2-year, risk-adjusted mortality rates were lower for drug-eluting stents than for bare-metal stents among all patients with myocardial infarction (10.7% vs. 12.8%, P=0.02), among patients with myocardial infarction with ST-segment elevation (8.5% vs. 11.6%, P=0.008), and among patients with myocardial infarction without ST-segment elevation (12.8% vs. 15.6%, P=0.04). The 2-year, risk-adjusted rates of recurrent myocardial infarction were reduced in patients with myocardial infarction without ST-segment elevation who were treated with drug-eluting stents, and repeat revascularization rates were significantly reduced with the use of drug-eluting stents as compared with bare-metal stents in all groups.
  
  
  CONCLUSIONS
  In patients presenting with acute myocardial infarction, treatment with drug-eluting stents is associated with decreased 2-year mortality rates and a reduction in the need for repeat revascularization procedures as compared with treatment with bare-metal stents.
authors.affiliation: Brigham and Women's Hospital, and Harvard Medical School, Boston, MA 02115, USA. lmauri1@partners.org
authors.forename: Laura
authors.initials: L
authors.lastname: Mauri
authors.forename: Treacy S
authors.initials: TS
authors.lastname: Silbaugh
authors.forename: Pallav
authors.initials: P
authors.lastname: Garg
authors.forename: Robert E
authors.initials: RE
authors.lastname: Wolf
authors.forename: Katya
authors.initials: K
authors.lastname: Zelevinsky
authors.forename: Ann
authors.initials: A
authors.lastname: Lovett
authors.forename: Manu R
authors.initials: MR
authors.lastname: Varma
authors.forename: Zheng
authors.initials: Z
authors.lastname: Zhou
authors.forename: Sharon-Lise T
authors.initials: SL
authors.lastname: Normand
mesh_terms: D000368:Aged; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D003627:Data Interpretation, Statistical; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome