Clinical outcome after primary percutaneous coronary intervention with drug-eluting and bare metal stents in patients with ST-segment elevation myocardial infarction.
BACKGROUND
The use of drug-eluting stents (DESs) versus bare metal stents (BMSs) in primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction is a matter of debate. Therefore, we examined the risk of target lesion revascularization (TLR), stent thrombosis, myocardial infarction, and death after the implantation of DES or BMS in primary PCI patients in Western Denmark.


RESULTS
A total of 3756 consecutive patients with ST-segment elevation myocardial infarction treated with primary PCI and stent implantation, recorded in the Western Denmark Heart Registry from January 2002 through June 2005, were followed up for 2 years. We used Cox regression analysis to control for confounding. The 2-year incidence of definite stent thrombosis was 1.9% in the DES group and 1.1% in the BMS group (adjusted relative risk [RR]=1.53; 95% CI=0.84 to 2.78; P=0.17). Very late definite stent thrombosis (> or =12 months) was seen in 0.4% in the DES group and 0.06% in the BMS group (adjusted RR=6.74; 95% CI=1.23 to 37.00; P=0.03). The 2-year incidence of myocardial infarction was similar in the 2 groups, 5.2% in the DES group versus 6.3% in the BMS group (P=0.28; adjusted RR=1.13; 95% CI=0.81 to 1.59; P=0.47). All-cause 2-year mortality was 7.8% in the DES group and 11.4% in BMS group (P<0.004; adjusted RR=0.79; 95% CI=0.60 to 1.04; P=0.09). The 2-year incidence of target lesion revascularization was 7.2% in the DES group and 8.7% in the BMS group (P=0.09; adjusted RR=0.70; 95% CI=0.52 to 0.92; P=0.012).


CONCLUSIONS
In ST-segment elevation myocardial infarction patients treated with primary PCI, target lesion revascularization was reduced by 30% in patients treated with a DES. The risk of very late definite stent thrombosis was low but increased in patients treated with DES. DES was not associated with increased risk of myocardial infarction or death, when compared with BMS.
Jensen
Lisette Okkels
LO
Department of Cardiology, Odense University Hospital, Sdr. Boulevard 29, Odense, Denmark. okkels@dadlnet.dk
Maeng
Michael
M
Thayssen
Per
P
Kaltoft
Anne
A
Tilsted
Hans Henrik
HH
Bøttcher
Morten
M
Lassen
Jens Flensted
JF
Hansen
Knud Nørregaard
KN
Krusell
Lars Romer
LR
Rasmussen
Klaus
K
Pedersen
Knud Erik
KE
Pedersen
Lars
L
Paaske Johnsen
Søren
S
Sørensen
Henrik Toft
HT
Thuesen
Leif
L
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015331:Cohort Studies; D003328:Coronary Thrombosis / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D011474:Prosthesis Design; D012042:Registries; D019233:Retreatment / Q000706:statistics & numerical data; D015607:Stents / Q000009:adverse effects