title: New generation drug-eluting stents for ST-elevation myocardial infarction: a new paradigm for safety.
abstract: OBJECTIVE
  The objective of this study is to compare the long-term safety of new generation drug-eluting stents (DES) with early generation DES and bare metal stents (BMS) for ST-segment elevation myocardial infarction (STEMI).
  
  
  BACKGROUND
  Early generation DES for STEMI have reduced target vessel revascularization, but have more very late ST compared with BMS raising concerns about their safety. New compared with early generation DES have lower rates of ST, but there are limited data in STEMI patients.
  
  
  METHODS
  From 2003 to 2011, 3,464 STEMI patients were treated with BMS (n = 1,187), early generation DES (n = 1,525), or new generation DES (n = 752) and were followed for 1-9 years.
  
  
  RESULTS
  Patients with new generation DES were younger, had less cardiogenic shock, and less prior infarction versus BMS, and more hypertension versus early generation DES. At 2 years, new generation DES had lower mortality (4.0% vs. 12.4%, P < 0.001), similar reinfarction (4.4% vs. 5.1%, P = 0.35), and less ST (1.4% vs. 3.8%, P = 0.031) versus BMS; and similar mortality (4.0% vs. 5.8%, P = 0.23), similar reinfarction (4.4% vs. 5.2%, P = 0.64), and trends for less ST (1.4% vs. 3.3%, P = 0.17) versus early generation DES. By Cox multivariable analyses, BMS had more ST than new generation DES (HR [95% CI] = 1.93 [1.01-3.66], P = 0.045).
  
  
  CONCLUSIONS
  New generation DES in STEMI patients have less ST compared to BMS and trends for less ST compared to early generation DES. These data suggest a new safety paradigm and should encourage the use of new generation DES in most STEMI patients treated with primary percutaneous coronary intervention (PCI).
authors.affiliation: Internal Medicine Residency Program, Cone Health, Greensboro, North Carolina.
authors.forename: Ankit
authors.initials: A
authors.lastname: Garg
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Brodie
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Stuckey
authors.forename: Ross F
authors.initials: RF
authors.lastname: Garberich
authors.forename: Patrick
authors.initials: P
authors.lastname: Tobbia
authors.forename: Charles
authors.initials: C
authors.lastname: Hansen
authors.forename: Grace
authors.initials: G
authors.lastname: Kissling
authors.forename: Hemal
authors.initials: H
authors.lastname: Kadakia
authors.forename: Daniel
authors.initials: D
authors.lastname: Lips
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Henry
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D054855:Drug-Eluting Stents; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D009657:North Carolina; D061214:Patient Safety; 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; D013997:Time Factors; D016896:Treatment Outcome
keywords: STEMI; everolimus-eluting stent; new generation DES; stent thrombosis