'Real world' comparison of drug-eluting stents vs bare metal stents in the treatment of unselected patients with acute ST-segment elevation myocardial infarction.
BACKGROUND
Concerns exist regarding the long-term efficacy and safety of drug-eluting stents (DES) in patients with ST-segment elevation myocardial infarction (STEMI). The study aimed to compare the mid- to long-term outcomes of DES vs bare metal stents (BMS) in patients with STEMI in a real-world setting.


RESULTS
Six hundred and eighty four consecutive patients with STEMI who underwent percutaneous coronary intervention from January 2003 to December 2006 were analyzed; 539 patients (78.8%) with DES and 145 (21.2%) with BMS. Patients were followed for the occurrence of target vessel failure (TVF); a composite of cardiac death, non-fatal myocardial infarction, or target vessel revascularization (TVR). After a follow-up duration of 36 months, the TVF rate was significant lower in the DES group compared with the BMS group (17.8% vs 34.5%, P<0.01), which was mainly driven by a decrease in TVR (9.1% vs 22.8%, P<0.01). Diabetic patients, those with multivessel disease and those treated with smaller or longer stents benefited more from DES implantation. Propensity score matching concordantly indicated a benefit of DES with regard to TVF (13.5% vs 34.2%; P<0.01). The overall incidence of stent thrombosis (ST) in each group was comparable (3.9% vs 4.1%, P=0.47).


CONCLUSIONS
Compared to BMS, the mid- to long-term outcome was better in patients receiving DES for acute STEMI. This was driven mainly by a reduction in repeat revascularization.
Park
Kyung Woo
KW
Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
Kang
Si-Hyuck
SH
Chung
Woo-Young
WY
Lee
Hae-Young
HY
Park
Jin-Shik
JS
Kang
Hyun-Jae
HJ
Cho
Young-Seok
YS
Youn
Tae-Jin
TJ
Koo
Bon-Kwon
BK
Chae
In-Ho
IH
Choi
Dong-Ju
DJ
Hahn
Seokyung
S
Park
Byung-Joo
BJ
Kim
Hyo-Soo
HS
D000368:Aged; D054855:Drug-Eluting Stents / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D009204:Myocardial Revascularization; D012042:Registries; D012189:Retrospective Studies; D015607:Stents / Q000592:standards* / Q000706:statistics & numerical data; D016896:Treatment Outcome