Comparison of drug-eluting stents to bare-metal stents in ST-elevation myocardial infarction in long-term follow-up.
BACKGROUND
Recent data from "real world" registries and some randomised trials concerning the safety and efficacy of drug-eluting stents (DES) in patients with acute ST-elevation myocardial infarction (STEMI) are equivocal.


OBJECTIVE
We sought to compare DES with bare-metal stents (BMS) in STEMI patients treated with primary percutaneous coronary intervention in terms of safety and efficacy parameters in long-term follow-up.


METHODS
895 consecutive STEMI patients admitted between 2003 and 2006 were included in this observational study. The clinical and procedural characteristic as well as long-term outcome of 327 patients treated with DES were compared with 568 patients treated with BMS. Combined primary endpoint consisted of: death, myocardial infarction (MI) and target vessel revascularisation (TVR).


RESULTS
Age, sex, risk factors, presence of 3-vessel disease, left ventricular ejection fraction and the use of IIb/IIIa antagonist were comparable in both groups. During a mean follow-up of 570 ± 490 days, the mortality rate was 8.9% in the DES group vs. 15.5% in the BMS group (p = 0.005). In the DES group, lower incidences of both death and MI (9.5% vs. 16%, p = 0.006) as well as the combined endpoint of death, MI and TVR (19.3% vs. 31.3%, p < 0.001) were recorded. Target lesion revascularisation was more frequently performed in the BMS group (13.4% vs. 8.6%, p = 0.03). However, patients who received BMS more frequently had history of MI and coronary interventions, Killip class > 1 on admission, lower level of haemoglobin and HDL-cholesterol and higher level of troponin than those who received DES. After adjustment, the use of BMS was no longer significantly associated with worse clinical outcome with a trend in favour of DES. The only independent factor associated with increased risk of the combined endpoint was the Killip class > 1 (p = 0.003).


CONCLUSIONS
In STEMI patients, DES are not inferior in comparison to BMS in terms of safety and efficacy parameters and seem to be associated with a lower rate of target lesion revascularisations. Additionally, Killip classification remains a simple and important classification used to stratify risk in patients with acute MI.
Department of Cardiology, Clinical Military Hospital, Wroclaw, Poland. pkubler75@gmail.com.
Piotr
P
Kübler
Ewa A
EA
Jankowska
Mirosław
M
Ferenc
Piotr
P
Ponikowski
Waldemar
W
Banasiak
Krzysztof
K
Reczuch
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D054855:Drug-Eluting Stents; D004562:Electrocardiography; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome
D008670:Metals; D010975:Platelet Aggregation Inhibitors