Long-term outcome after drug-eluting versus bare-metal stent implantation in patients with ST-segment elevation myocardial infarction: 3-year follow-up of the randomized DEDICATION (Drug Elution and Distal Protection in Acute Myocardial Infarction) Trial.
OBJECTIVE
The purpose of this study was to compare long-term clinical outcomes after implantation of drug-eluting stents (DES) and bare-metal stents (BMS) in patients with ST-segment elevation myocardial infarction (STEMI).


BACKGROUND
The evidence of long-term efficacy and safety after implantation of DES in patients with complex lesions is scarce.


METHODS
We randomly assigned 626 patients with STEMI referred within 12 h to have a DES or a BMS implanted in the infarct-related lesion with or without distal protection during primary percutaneous coronary intervention.


RESULTS
At 3 years, target lesion revascularization was 6.1% in the DES group compared with 16.3% in the BMS group (p<0.001), and the rate of major adverse cardiac events was 11.5% versus 18.2%, respectively (p=0.02). Whereas all-cause mortality did not differ significantly, the rate of cardiac death was higher in the DES group, 6.1% versus 1.9% for the BMS group (p=0.01). The occurrence of reinfarction, stroke, and stent thrombosis was similar.


CONCLUSIONS
Implantation of DES in patients with STEMI reduces the long-term rate of major adverse cardiac events compared with BMS, but patients with DES had a higher risk of cardiac death not attributed to myocardial infarction or stent thrombosis. (Drug Elution and Distal Protection During Percutaneous Coronary Intervention in ST Elevation Myocardial Infarction [DEDICATION]; NCT00192868)
Kaltoft
Anne
A
Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.
Kelbaek
Henning
H
Thuesen
Leif
L
Lassen
Jens Flensted
JF
Clemmensen
Peter
P
Kløvgaard
Lene
L
Engstrøm
Thomas
T
Bøtker
Hans E
HE
Saunamäki
Kari
K
Krusell
Lars R
LR
Jørgensen
Erik
E
Tilsted
Hans-Henrik
HH
Christiansen
Evald H
EH
Ravkilde
Jan
J
Køber
Lars
L
Kofoed
Klaus F
KF
Terkelsen
Christian J
CJ
Helqvist
Steffen
S
D000800:Angioplasty, Balloon; D054855:Drug-Eluting Stents / Q000009:adverse effects; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015607:Stents / Q000009:adverse effects; D015996:Survival Rate; D013927:Thrombosis / Q000209:etiology