Outcomes of drug-eluting stents compared to bare-metal stents in ST-segment elevation acute myocardial infarction.
BACKGROUND
Primary percutaneous coronary intervention (PPCI) has become the treatment of choice in patients with ST-segment elevation myocardial infarction (STEMI). Drug-eluting stents (DES) reduce restenosis compared to bare-metal stents (BMS) but there is conflicting data concerning their use in the setting of STEMI. We aimed to evaluate the influence of the type of stent on the outcomes of PPCI.


METHODS
This was a single-center longitudinal study including 213 consecutive patients (76% men, mean age 60 +/- 12 years) with STEMI undergoing PPCI between 2003 and 2007, divided into two groups: BMS (43.7%) and DES (56.3%). We assessed clinical and demographic features as well as angiographic and electrocardiographic signs of myocardial reperfusion. The composite outcome of death, myocardial infarction (MI) or target-lesion revascularization (TLR) was evaluated.


RESULTS
At a median follow-up of 26 months there were no differences in the composite outcome of death/MI/TLR (BMS 18.3% vs DES 15.8%) or in the incidence of stent thrombosis. Angiographic results of the procedure were also similar. Independent predictors of the composite outcome were age (HR = 1.06, 95% CI [1 .02-1.11], left anterior descending artery as infarct-related vessel (HR = 2.69, 95% CI [1.17-6.19]) and use of glycoprotein IIb/IIIa inhibitors (HR = 0.33, 95% CI [0.13-0.83]).


CONCLUSIONS
There was no benefit in angiographic outcomes or major cardiac events after treatment with drug-eluting stents compared to bare-metal stents in this group of patients with STEMI.
Serviço de Cardiogia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal. jdbrito@netcabo.pt
João
J
Brito
Manuel
M
Almeida
Rui Campante
RC
Teles
Pedro
P
Sousa
João
J
Abecasis
Rita
R
Calé
Pedro
P
Gonçalves
Luís
L
Raposo
Miguel
M
Mendes
D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D011474:Prosthesis Design; D015607:Stents; D016896:Treatment Outcome