Very late thrombosis in acute myocardial infarction: drug-eluting versus uncoated stents.
OBJECTIVE
To evaluate clinical outcomes at 24 months in an unselected population with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) with drug eluting stents (DES), as compared with bare metal stents (BMS).


RESULTS
We report our series of 245 consecutive patients with STEMI undergoing PCI with DES (n=117) or BMS (n=128) from January 2003 to August 2005. The primary endpoint was the incidence of major adverse cardiac events (MACE) assessed at 24 months. The secondary endpoint was the incidence of stent thrombosis according to the Academic Research Consortium classification. Propensity score was used to adjust groups for baseline and angiographic characteristics. The adjusted rate of the primary endpoint was lower in DES as compared with BMS group (15.2% vs 25.7%; HR 0.6 [95% CI 0.3-1.11, p=0.1), driven by a significant reduction of TVR (10.1% vs 23.0%; HR 0.4 [95% CI 0.2-1.01, p=0.03), without any significant difference regarding the composite end point of death and recurrent myocardial infarction (7.6% vs 5.4%; HR 1.4 [95% CI 0.4-5.01, p=0.6). The cumulative incidence of stent thrombosis was 5.3% in DES vs 0.8% in BMS group (p=0.06).


CONCLUSIONS
The use of DES in STEMI was associated with lower TVR rates, but no differences were observed about death and myocardial infarction at 24 months, as compared with BMS.
Garro
Nadia
N
Department of Cardiovascular Diseases, Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy.
Capodanno
Davide
D
Cammalleri
Valeria
V
Tamburino
Corrado
C
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000706:statistics & numerical data; D015897:Comorbidity; D003328:Coronary Thrombosis / Q000453:epidemiology / Q000209:etiology*; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D015994:Incidence; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy*; D016016:Proportional Hazards Models; D020123:Sirolimus / Q000008:administration & dosage; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D008670:Metals; D020123:Sirolimus