title: Outcomes with drug-eluting stents versus bare metal stents in acute ST-elevation myocardial infarction: results from the Strategic Transcatheter Evaluation of New Therapies (STENT) Group.
abstract: OBJECTIVE
  This study compares outcomes with drug-eluting stents (DES) versus bare metal stents (BMS) in patients with ST-elevation myocardial infarction (STEMI).
  
  
  BACKGROUND
  DESs have been effective in elective percutaneous coronary intervention (PCI), but their safety and efficacy in patients with STEMI have not been well studied.
  
  
  METHODS
  The STENT Registry is a multicenter United States registry evaluating outcomes of DES. Our study population includes patients with STEMI treated with either a DES or BMS who completed 9-month or 2-year follow-up. Outcomes were adjusted using propensity score analysis.
  
  
  RESULTS
  DES patients were younger, had less prior infarction and prior bypass surgery, but had smaller vessels and longer lesions. After adjusting for differences in baseline variables, there were no significant differences between DES and BMS in death, reinfarction, or major adverse cardiac events (MACE). DES had lower rates of stent thrombosis at 9 months (1.0% vs. 2.7%, HR 0.40 [0.17-0.95]) and lower rates of target vessel revascularization (TVR) at 9 months (4.0% vs. 7.5%, HR 0.55 [0.34-0.88]) and 2 years (8.0% vs. 11.3%, HR 0.57 [0.35-0.92]). There was a nonsignificant increase in stent thrombosis with DES versus BMS from 1 to 2 years (1.1% vs. 0.3%, P = 0.28).
  
  
  CONCLUSIONS
  Our data suggest that DES used with primary PCI for STEMI are more effective than BMS in reducing TVR and are safe for up to 2 years. Whether DES are safe beyond 2 years and whether the reduction in TVR is enough to justify their use in STEMI will have to wait for the results of large randomized trials.
authors.affiliation: The LeBauer Cardiovascular Research Foundation, Greensboro, North Carolina, USA. bbrodie@triad.rr.com
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Brodie
authors.forename: Thomas
authors.initials: T
authors.lastname: Stuckey
authors.forename: William
authors.initials: W
authors.lastname: Downey
authors.forename: Angela
authors.initials: A
authors.lastname: Humphrey
authors.forename: Marcy
authors.initials: M
authors.lastname: Nussbaum
authors.forename: Sherry
authors.initials: S
authors.lastname: Laurent
authors.forename: Barbara
authors.initials: B
authors.lastname: Bradshaw
authors.forename: Chris
authors.initials: C
authors.lastname: Metzger
authors.forename: James
authors.initials: J
authors.lastname: Hermiller
authors.forename: Fred
authors.initials: F
authors.lastname: Krainin
authors.forename: Stanley
authors.initials: S
authors.lastname: Juk
authors.forename: Barry
authors.initials: B
authors.lastname: Cheek
authors.forename: Peter
authors.initials: P
authors.lastname: Duffy
authors.forename: Charles A
authors.initials: CA
authors.lastname: Simonton
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality; D017023:Coronary Angiography; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011474:Prosthesis Design; D012008:Recurrence; D012042:Registries; D018570:Risk Assessment; D015607:Stents; D013927:Thrombosis / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D008670:Metals