title: Comparison of late (3-year) registry data outcomes using bare metal versus drug-eluting stents for treating ST-segment elevation acute myocardial infarctions.
abstract: Clinical trial data have supported the safety and efficacy of drug-eluting stents (DES) in the treatment of patients with ST-segment elevation myocardial infarctions (STEMIs), but contemporary "real-world" registry data regarding the late safety profiles of DES are limited. This prospective registry-based study included 1,569 consecutive unselected patients with STEMIs who underwent emergency primary percutaneous coronary intervention from January 2001 to December 2009. Of the study cohort, 200 patients (12.7%) received DES, while 1,369 patients (87.3%) underwent bare-metal stent (BMS) placement. The primary end points of the study were all-cause mortality and target vessel revascularization at 1, 2, and 3 years. Survival status was assessed by municipal civil registries. Repeat revascularization procedures were prospectively collected in the hospital database. All-cause mortality was significantly lower in the DES group at 3 years (4.2% vs 13.5%, p = 0.007) compared to BMS-treated patients, but DES use was not an independent predictor of all-cause mortality (adjusted odds ratio 0.5, 95% confidence interval 0.2 to 1.2, p = 0.10). Target vessel revascularization was significantly lower in the DES group compared to the BMS group at 3 years (10.5% vs 21%, p = 0.001). DES use was an independent predictor of reduced target vessel revascularization (adjusted odds ratio 0.44, 95% confidence interval 0.25 to 0.77, p = 0.004). Late definite stent thrombosis occurring after 1 year occurred in 4 (2.5%) patients in the DES group compared to 6 (0.7%) in the BMS group (p = 0.05). DES use was an independent predictor of late stent thrombosis (adjusted odds ratio 8.6, 95% confidence interval 1.9 to 38, p = 0.004). In conclusion, this contemporary registry-based study of patients who underwent primary percutaneous coronary intervention for STEMI demonstrated improved revascularization rates without increased 3-year hazard of adverse clinical outcomes in DES-treated patients.
authors.affiliation: Department of Cardiology, Rabin Medical Centre, Petah-Tikva, Tel-Aviv University, Tel-Aviv, Israel. aassali@netvision.net.il
authors.forename: Abid
authors.initials: A
authors.lastname: Assali
authors.forename: Muthiah
authors.initials: M
authors.lastname: Vaduganathan
authors.forename: Hanna
authors.initials: H
authors.lastname: Vaknin-Assa
authors.forename: Eli I
authors.initials: EI
authors.lastname: Lev
authors.forename: David
authors.initials: D
authors.lastname: Brosh
authors.forename: Igal
authors.initials: I
authors.lastname: Teplitsky
authors.forename: Tamir
authors.initials: T
authors.lastname: Bental
authors.forename: Alexander
authors.initials: A
authors.lastname: Battler
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowski
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D023921:Coronary Stenosis / Q000401:mortality / Q000628:therapy; D003328:Coronary Thrombosis / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000627:therapeutic use; D057216:Propensity Score; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D051437:Renal Insufficiency / Q000453:epidemiology; D019233:Retreatment; D015607:Stents
chemical_list: D019039:Platelet Glycoprotein GPIIb-IIIa Complex