Drug-eluting stents versus bare-metal stents in acute ST-segment elevation myocardial infarction. a single-center experience with long-term follow up.
OBJECTIVE
To compare the efficacy and safety of drugeluting stents (DES) vs. bare-metal stents (BMS) in patients with acute ST-segment-elevation myocardial infarction (STEMI).


BACKGROUND
DES effectively reduce restenosis in elective percutaneous coronary intervention. Limited data are available about the use of DES in patients with STEMI.


METHODS
453 consecutive patients who presented with STEMI between July 2003 and May 2006 were studied. The procedural characteristics, 30-day, 12-, 18- and 26-month outcomes of 277 patients treated with DES were compared with 176 patients treated with BMS.


RESULTS
At 26-month follow up, DES therapy was associated with a significant decrease in major adverse cardiac events (MACE) (relative risk [RR] -35%; p = 0.01) and target lesion revascularization [TLR], RR -64%; p = 0.009). The DES group included more diabetic patients (20% vs. 9%; p < 0.001), and the stents were longer (22 +/- 0.28 mm vs. 19.4 +/- 0.36 mm; p < 0.001) and smaller (diameter: 2.9 +/- 0.02 mm vs. 3.1 +/- 0.02 mm; p < 0.001). The rate of stent thrombosis was similar and the prolonged combined antiplatelet therapy was an independent factor predicting a protective effect on MACE.


CONCLUSIONS
DES reduce the incidence of TLR and MACE in patients with STEMI without evidence of additional risks at 2-year follow up. DES therapy was associated with more complex interventional techniques, which yielded similar procedural results and clinical outcomes that may be influenced by prolonged combined antiplatelet therapy.
Palmieri
Cataldo
C
Gabriele Monasterio Foundation, and Institute of Clinical Physiology CNR, National Research Council G Pasquinucci Hospital, Massa, Italy.
Ravani
Marcello
M
Trianni
Giuseppe
G
Gianetti
Jacopo
J
Vaghetti
Marco
M
Rizza
Antonio
A
Paradossi
Umberto
U
Beqiri
Arton
A
Berti
Sergio
S
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage*; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage*; D015331:Cohort Studies; D017023:Coronary Angiography; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D017239:Paclitaxel / Q000008:administration & dosage*; D011474:Prosthesis Design; D012008:Recurrence; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage*; D016896:Treatment Outcome
D000903:Antibiotics, Antineoplastic; D000972:Antineoplastic Agents, Phytogenic; D008670:Metals; D017239:Paclitaxel; D020123:Sirolimus