title: Long-term outcome after drug eluting stenting in patients with ST-segment elevation myocardial infarction: data from the REAL registry.
abstract: BACKGROUND
  The long-term safety and efficacy of drug eluting stents (DES) implanted during primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) is unclear. The purpose of this study was to compare the long-term outcome of STEMI patients undergoing primary PCI with DES vs. bare metal stent (BMS) implantation.
  
  
  METHODS
  In the present analysis 4764 patients were enrolled (706, 15%, received DES). We assessed the cumulative incidence of major adverse cardiac events (MACE) and stent thrombosis (ST).
  
  
  RESULTS
  Overall, no significant difference emerged for the rates of death and reinfarction. DES implantation was associated to a reduction of target vessel revascularization (TVR) (HR 0.65, 95%CI 0.47-0.91; p=0.01), leading to a MACE reduction (HR 0.7, 95%CI 0.56-0.86; p<0.01). In particular, during the first 2 years we observed less adverse events in the DES group, mainly because of a lower TVR rate (TVR: HR 0.56, 95%CI 0.37-0.83, p<0.01; MACE: HR 0.71, 95%CI 0.54-0.94, p=0.01). On the contrary, during the third year, adverse events tended to be higher in the DES group. ST did not differ between DES and BMS groups (p=0.6). No differences were observed between sirolimus eluting stents and paclitaxel eluting stents.
  
  
  CONCLUSIONS
  DES implantation during primary PCI is safe and associated with a significant TVR and MACE reduction in the first two years, whereas a trend to have more adverse events in the third year is observed. More data about long-term follow-up are needed to better evaluate both safety and efficacy of DES in the setting of STEMI.
authors.affiliation: Unità Operativa di Cardiologia, Azienda Ospedaliera Universitaria S. Anna, Ferrara, Italy. cmpglc@unife.it
authors.forename: Gianluca
authors.initials: G
authors.lastname: Campo
authors.forename: Francesco
authors.initials: F
authors.lastname: Saia
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Percoco
authors.forename: Antonio
authors.initials: A
authors.lastname: Manari
authors.forename: Andrea
authors.initials: A
authors.lastname: Santarelli
authors.forename: Luigi
authors.initials: L
authors.lastname: Vignali
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Varani
authors.forename: Alberto
authors.initials: A
authors.lastname: Benassi
authors.forename: Pietro
authors.initials: P
authors.lastname: Sangiorgio
authors.forename: Fabio
authors.initials: F
authors.lastname: Tarantino
authors.forename: Paolo
authors.initials: P
authors.lastname: Magnavacchi
authors.forename: Rossana
authors.initials: R
authors.lastname: De Palma
authors.forename: Paolo
authors.initials: P
authors.lastname: Guastaroba
authors.forename: Antonio
authors.initials: A
authors.lastname: Marzocchi
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D023903:Coronary Restenosis / Q000453:epidemiology*; D003328:Coronary Thrombosis / Q000453:epidemiology*; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000706:statistics & numerical data*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D017239:Paclitaxel / Q000627:therapeutic use; D012042:Registries / Q000706:statistics & numerical data; D020123:Sirolimus / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D007166:Immunosuppressive Agents; D017239:Paclitaxel; D020123:Sirolimus