title: Bare-metal stenting of large coronary arteries in ST-elevation myocardial infarction is associated with low rates of target vessel revascularization.
abstract: BACKGROUND
  During percutaneous coronary intervention (PCI) performed in the emergent setting of ST-segment elevation myocardial infarction (STEMI), uncertainty about patients' ability to comply with 12 months dual antiplatelet therapy after drug-eluting stenting is common, and thus, selective bare-metal stent (BMS) deployment could be an attractive strategy if this achieved low target vessel revascularization (TVR) rates in large infarct-related arteries (IRAs) (≥3.5 mm).
  
  
  RESULTS
  To evaluate this hypothesis, among 1,282 patients with STEMI who underwent PCI during their initial hospitalization, we studied 1,059 patients (83%) who received BMS, of whom 512 (48%) had large IRAs ≥3.5 mm in diameter, 333 (31%) had IRAs 3 to 3.49 mm, and 214 (20%) had IRAs <3 mm. At 1 year, TVR rate in patients with BMS was 5.8% (2.2% with large BMS [≥3.5 mm], 9.2% with BMS 3-3.49 mm [intermediate], and 9.0% with BMS <3.0 mm [small], P < .001). The rates of death/reinfarction among patients with large BMS compared with intermediate BMS or small BMS were lower (6.6% vs 11.7% vs 9.0%, P = .042). Among patients who received BMS, the independent predictors of TVR at 1 year were the following: vessel diameter <3.5 mm (odds ratio [OR] 4.39 [95% CI 2.24-8.60], P < .001), proximal left anterior descending coronary artery lesions (OR 1.89 [95% CI 1.08-3.31], P = .027), hypertension (OR 2.01 [95% CI 1.17-3.438], P = .011), and prior PCI (OR 3.46 [95% CI 1.21-9.85], P = .02). The predictors of death/myocardial infarction at 1 year were pre-PCI cardiogenic shock (OR 8.16 [95% CI 4.16-16.01], P < .001), age ≥65 years (OR 2.63 [95% CI 1.58-4.39], P < .001), left anterior descending coronary artery culprit lesions (OR 1.95 [95% CI 1.19-3.21], P = .008), female gender (OR 1.93 [95% CI 1.12-3.32], P = .019), and American College of Cardiology/American Heart Association lesion classes B2 and C (OR 2.17 [95% CI 1.10-4.27], P = .026).
  
  
  CONCLUSIONS
  Bare-metal stent deployment in STEMI patients with IRAs ≥3.5 mm was associated with low rates of TVR. Their use in this setting warrants comparison with second-generation drug-eluting stenting deployment in future randomized clinical trials.
authors.affiliation: South Western Sydney Clinical School, The University of New South Wales, NSW, Australia.
authors.forename: Ibrahim M
authors.initials: IM
authors.lastname: Shugman
authors.forename: Leia
authors.initials: L
authors.lastname: Hee
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Mussap
authors.forename: Patrick
authors.initials: P
authors.lastname: Diu
authors.forename: Sidney
authors.initials: S
authors.lastname: Lo
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Hopkins
authors.forename: Phong
authors.initials: P
authors.lastname: Nguyen
authors.forename: David
authors.initials: D
authors.lastname: Taylor
authors.forename: Rohan
authors.initials: R
authors.lastname: Rajaratnam
authors.forename: Dominic
authors.initials: D
authors.lastname: Leung
authors.forename: Liza
authors.initials: L
authors.lastname: Thomas
authors.forename: Craig P
authors.initials: CP
authors.lastname: Juergens
authors.forename: John K
authors.initials: JK
authors.lastname: French
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012008:Recurrence; D018570:Risk Assessment; D015607:Stents; D016896:Treatment Outcome