Mortality following placement of drug-eluting and bare-metal stents for ST-segment elevation acute myocardial infarction in the Global Registry of Acute Coronary Events.
OBJECTIVE
To assess mortality after drug-eluting stent (DES) or bare-metal stent (BMS) for ST-segment elevation myocardial infarction (STEMI).


RESULTS
In this multinational registry, 5093 STEMI patients received a stent: 1313 (26%) a DES and 3780 (74%) only BMS. Groups differed in baseline characteristics, type, or timing of percutaneous coronary intervention, with a higher baseline risk for patients receiving BMS. Two-year follow-up was available in 55 and 60% of the eligible BMS and DES patients, respectively. Unadjusted mortality was lower during hospitalization, similar for the first 6 months after discharge, and higher from 6 months to 2 years, for DES patients compared with that of BMS patients. Overall, unadjusted 2-year mortality was 5.3 vs. 3.9% for BMS vs. DES patients (P = 0.04). In propensity- and risk-adjusted survival analyses (Cox model), post-discharge mortality was not different up to 6 months (P = 0.21) or 1 year (P = 0.34). Late post-discharge mortality was higher in DES patients from 6 months to 2 years (HR 4.90, P = 0.01) or from 1 to 2 years (HR 7.06, P = 0.02). Similar results were observed when factoring in hospital mortality.


CONCLUSIONS
The observation of increased late mortality with DES vs. BMS suggests that DES should probably be avoided in STEMI, until more long-term data become available.
Steg
Ph Gabriel
PG
INSERM U-698 'Recherche Clinique en Athérothrombose', Université Paris VII-Denis Diderot, Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Bichat-Claude Bernard, 46 rue Henri Huchard, 75877 Paris Cedex 18, France. gabriel.steg@bch.aphp.fr
Fox
Keith A A
KA
Eagle
Kim A
KA
Furman
Mark
M
Van de Werf
Frans
F
Montalescot
Gilles
G
Goodman
Shaun G
SG
Avezum
Alvaro
A
Huang
Wei
W
Gore
Joel M
JM
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation / Q000401:mortality; D000075202:Contraindications; D054855:Drug-Eluting Stents / Q000009:adverse effects* / Q000706:statistics & numerical data; D004562:Electrocardiography; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015607:Stents / Q000009:adverse effects / Q000706:statistics & numerical data