title: Long-term outcome after drug-eluting versus bare-metal stent implantation in patients with ST-segment elevation myocardial infarction: 5 years follow-up from the randomized DEDICATION trial (Drug Elution and Distal Protection in Acute Myocardial Infarction).
abstract: OBJECTIVE
  This study sought to compare the long-term effects of drug-eluting stent (DES) compared with bare-metal stent (BMS) implantation in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention.
  
  
  BACKGROUND
  The randomized DEDICATION (Drug Elution and Distal Protection in Acute Myocardial Infarction) trial evaluated the outcome after DES compared with BMS implantation in patients with STEMI undergoing primary percutaneous coronary intervention.
  
  
  METHODS
  Patients with a high-grade stenosis/occlusion of a native coronary artery presenting with symptoms <12 h and ST-segment elevation were enrolled after giving informed consent. Patients were randomly assigned to receive a DES or a BMS in the infarct-related lesion. Patients were followed for at least 5 years, and clinical endpoints were evaluated from population registries and hospital charts. The main endpoint was the occurrence of the first major adverse cardiac event (MACE), defined as cardiac death, nonfatal recurrent myocardial infarction, and target lesion revascularization.
  
  
  RESULTS
  Complete clinical status was available in 623 patients (99.5%) at 5 years follow-up. The combined MACE rate was insignificantly lower in the DES group (16.9% vs. 23%), mainly driven by a lower need of repeat revascularization (p = 0.07). Whereas the number of deaths from all causes tended to be higher in the DES group (16.3% vs. 12.1%, p = 0.17), cardiac mortality was significantly higher (7.7% vs. 3.2%, p = 0.02). The 5-year stent thrombosis rates were generally low and similar between the DES and the BMS groups. No cardiac deaths occurring within 1 month could be clearly ascribed to stent thrombosis, whereas stent thrombosis was involved in 78% of later-occurring deaths.
  
  
  CONCLUSIONS
  The 5-year MACE rate was insignificantly different, but the cardiac mortality was higher after DES versus BMS implantation in patients with STEMI. Stent thrombosis was the main cause of late cardiac deaths.
authors.affiliation: Department of Cardiology and Cardiac Catheterization Laboratory, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Lene
authors.initials: L
authors.lastname: Holmvang
authors.forename: Henning
authors.initials: H
authors.lastname: Kelbæk
authors.forename: Anne
authors.initials: A
authors.lastname: Kaltoft
authors.forename: Leif
authors.initials: L
authors.lastname: Thuesen
authors.forename: Jens Flensted
authors.initials: JF
authors.lastname: Lassen
authors.forename: Peter
authors.initials: P
authors.lastname: Clemmensen
authors.forename: Lene
authors.initials: L
authors.lastname: Kløvgaard
authors.forename: Thomas
authors.initials: T
authors.lastname: Engstrøm
authors.forename: Hans E
authors.initials: HE
authors.lastname: Bøtker
authors.forename: Kari
authors.initials: K
authors.lastname: Saunamäki
authors.forename: Lars R
authors.initials: LR
authors.lastname: Krusell
authors.forename: Erik
authors.initials: E
authors.lastname: Jørgensen
authors.forename: Hans-Henrik
authors.initials: HH
authors.lastname: Tilsted
authors.forename: Evald H
authors.initials: EH
authors.lastname: Christiansen
authors.forename: Jan
authors.initials: J
authors.lastname: Ravkilde
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.forename: Klaus Fuglsang
authors.initials: KF
authors.lastname: Kofoed
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Terkelsen
authors.forename: Steffen
authors.initials: S
authors.lastname: Helqvist
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D023921:Coronary Stenosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology / Q000401:mortality; D003718:Denmark; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008670:Metals