title: Are drug-eluting stents safer and more effective than bare-metal stents in patients with acute myocardial infarction?
abstract: Questions about the long-term safety over the beneficial effects of drug-eluting stents (DES) have grown. We compared the long-term safety and efficacy of DES and bare-metal stents (BMS) in patients with acute myocardial infarction (AMI). A total of 1,017 AMI patients treated with stent implantation were followed for 3 years; 660 (64.9%) patients were treated with at least one DES and 357 (35.1%) patients were treated with at least one BMS. The primary endpoints were total mortality and the composite of major adverse cardiac events (MACE) including total mortality, re-MI, target lesion revascularization (TLR), and coronary artery bypass graft. At 3-years, the overall risks of cardiac and all-cause mortality were not different between the groups. However, the use of DES significantly decreased TLR (17.4% versus 7.1%, adjusted hazard ratio [HR] 0.44, 95% confidence interval [CI] 0.30 to 0.65) and the composite of MACEs (27.2% versus 19.5%, adjusted HR 0.65, 95% CI 0.48 to 0.87) with no differences in MI. The risk of MACE up to 1 year (HR 0.56, 95% CI 0.39 to 0.80) was higher in BMS patients, whereas from 1 year to 2 years (HR 0.55, 95% CI 0.27 to 1.10) and from 2 years to 3 years (HR 1.13, 95% CI 0.56 to 2.28), it was similar between the groups. The use of DES does not have a significant effect on overall long-term clinical survival compared with that of BMS in AMI patients. However, the use of DES reduced the need for re-intervention and the risk of MACE, mostly within 1 year.
authors.affiliation: Department of Cardiology, Chonnam National University Hospital, Dwangju, Republic of Korea.
authors.forename: Ki Hong
authors.initials: KH
authors.lastname: Lee
authors.forename: Youngkeun
authors.initials: Y
authors.lastname: Ahn
authors.forename: Nam Sik
authors.initials: NS
authors.lastname: Yoon
authors.forename: Hyun Ju
authors.initials: HJ
authors.lastname: Yoon
authors.forename: Young Joon
authors.initials: YJ
authors.lastname: Hong
authors.forename: Kye Hun
authors.initials: KH
authors.lastname: Kim
authors.forename: Hyung Wook
authors.initials: HW
authors.lastname: Park
authors.forename: Ju Han
authors.initials: JH
authors.lastname: Kim
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Jeong Gwan
authors.initials: JG
authors.lastname: Cho
authors.forename: Jong Chun
authors.initials: JC
authors.lastname: Park
authors.forename: Jung Chaee
authors.initials: JC
authors.lastname: Kang
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D016896:Treatment Outcome