Comparison of long-term outcomes in STEMI and NSTE-ACS after coronary stent placement: an analysis in a real world BMS and DES population.
OBJECTIVE
The prognostic difference between STEMI and NSTE-ACS after coronary stent placement remains unclear. We aimed to compare the short- and long-term event rates in patients presenting with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS) after percutaneous coronary intervention (PCI) with either bare-metal stents (BMS) or drug-eluting stents (DES).


METHODS
Between 2000 and 2005 a total of 1749 STEMI and 1921 NSTE-ACS patients received either a BMS or DES in consecutive real world cohorts. Descriptive statistics and multivariate survival analyses were applied to compare the event rates in STEMI and NSTE-ACS during 4 years follow-up.


RESULTS
NSTE-ACS patients had significantly higher clinical and angiographic risk profiles at baseline and were treated with less optimal medical therapy during follow-up. At 4 years follow-up, all-cause mortality was significantly higher in STEMI compared to NSTE-ACS after coronary stent placement (17.4% vs. 14.3%; HR 1.60, 95% CI 1.24-2.07). In a landmark analysis no difference was seen in all-cause mortality among STEMI en NSTE-ACS between 1 month and 4 years follow-up (HR 1.10, 95% CI 0.81-1.51). Cardiac death was more prevalent in STEMI patients, while the 4-year cumulative incidences of any myocardial infarction, any coronary revascularization, target lesion revascularization and definite stent thrombosis were similar in both ACS groups.


CONCLUSIONS
Patients presenting with STEMI have a worse long-term prognosis compared to NSTE-ACS after coronary stent placement, due to higher short-term death rates. However, after the first month STEMI and NSTE-ACS patients have a comparable long-term survival.
Department of Cardiology, Erasmus MC, Thoraxcenter, Rotterdam, the Netherlands. m.a.h.vanleeuwen@erasmusmc.nl
Maarten A H
MA
van Leeuwen
Joost
J
Daemen
Nicolas M
NM
van Mieghem
Sanneke P M
SP
de Boer
Eric
E
Boersma
Robert J
RJ
van Geuns
Felix
F
Zijlstra
Ron T
RT
van Domburg
Patrick W J C
PW
Serruys
D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D000368:Aged; D015331:Cohort Studies; D054855:Drug-Eluting Stents / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000639:trends; D011159:Population Surveillance / Q000379:methods*; D012042:Registries; D015607:Stents / Q000639:trends; D016896:Treatment Outcome