Comparison of drug-eluting stents versus bare-metal stents for treating ST-segment elevation myocardial infarction.
OBJECTIVE
We sought to examine the clinical outcomes of patients treated with drug-eluting stents (DES) compared with bare-metal stents (BMS) during primary angioplasty for ST-segment elevation myocardial infarction (STEMI).


BACKGROUND
Pathophysiologic studies suggest that the use of DES for STEMI may be associated with stent thrombosis and increased clinical events. However, although short-term data exist, long-term follow-up is lacking.


METHODS
Patients who presented with STEMI from January 2002 to May 2007 to our institution were included. In addition to multivariable adjusted analysis, propensity analysis for stent choice was performed. The primary end point was the composite of death or target lesion revascularization (TLR).


RESULTS
Of the 804 patients, 699 underwent stenting and met our study criteria. There were 152 composite events over a median follow-up of 1.7 years. In a multivariable Cox model, DES use was associated with a trend toward lower death or TLR compared with BMS (adjusted hazard ratio [HR] 0.72, 95% confidence interval [CI], 0.50 to 1.02, p = 0.06). However, this was mainly due to lower TLR (adjusted HR 0.60, 95% CI, 0.36 to 0.98, p = 0.043). Similarly, DES was associated with a trend toward lower death or TLR compared with BMS in the propensity-matched patients (adjusted HR 0.65, 95% CI 0.42 to 1.00, p = 0.05). This was mainly due to lower TLR in the DES patients (adjusted HR 0.52, 95% CI 0.28 to 0.96, p = 0.04).


CONCLUSIONS
Both DES and BMS are effective in the setting of STEMI; however, DES is associated with lower TLR without an increase in all-cause mortality.
Shishehbor
Mehdi H
MH
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Amini
Reza
R
Oliveria
Leonardo P J
LP
Singh
Inder M
IM
Kelly
Peter
P
Bhatt
Deepak L
DL
Kapadia
Samir R
SR
Ellis
Stephen G
SG
Whitlow
Patrick L
PL
Brener
Sorin J
SJ
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / 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 / Q000209:etiology / Q000401:mortality / Q000517:prevention & control / Q000628:therapy*; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011474:Prosthesis Design; D012042:Registries; D018570:Risk Assessment; D015607:Stents; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome
D008670:Metals; D010975:Platelet Aggregation Inhibitors