title: Comparison between drug-eluting and bare metal stent on ST-elevation myocardial infarction outcome: should second-generation drug-eluting stent be preferred?
abstract: OBJECTIVE
  Although several studies reported that drug-eluting stents (DES) are able to reduce restenosis incidence without increasing mortality, concerns still exist about their safety in ST-segment elevation myocardial infarction (STEMI) patients mainly for a possible higher rate of in-stent thrombosis. Recent evidence suggests a better safety profile of second-generation DES, but data on their outcome in STEMI are still poor. In this study we evaluated the impact on mortality and target lesion revascularization (TLR) of DES or bare metal stent (BMS) implantation in STEMI patients submitted to primary angioplasty.
  
  
  METHODS
  We analyzed mortality and TLR in 1150 STEMI patients during a mean 43-month follow-up after DES (44.6%) or BMS (55.4%) implantation. A propensity score method was used to minimize bias. During follow-up, 223 deaths occurred.
  
  
  RESULTS
  Unadjusted for potential confounders, DES implantation was associated with a significant reduction in all-cause mortality [hazard ratio (HR) 0.40; 95%CI 0.30-0.54] and TLR (HR 0.55; 95%CI 0.36-0.86); this latter was confirmed after propensity score analysis (HR 0.39; 95%CI 0.21-0.67). Second- (n=179) vs. first- (n=337) generation DES showed a further reduction in TLR (HR 0.17; 95%CI 0.05-0.57). Adjusted analyses showed a significant reduction in the combined end-point of all-cause mortality or TLR after both first- and second-generation DES vs. BMS implantation with a trend to a lower risk for second- vs. first-generation DES.
  
  
  CONCLUSIONS
  DES implantation in STEMI patients showed a significant reduction in TLR and in the combined endpoint of TLR or mortality. Second-generation DES showed a more protective effect on the combined endpoint, suggesting that they would be preferred in this setting.
authors.affiliation: Dipartimento del Cuore e dei Vasi, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy. Electronic address: cristinagiglioli@yahoo.it.
authors.forename: Cristina
authors.initials: C
authors.lastname: Giglioli
authors.affiliation: Dipartimento del Cuore e dei Vasi, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Cecchi
authors.affiliation: Dipartimento del Cuore e dei Vasi, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
authors.forename: Leonard
authors.initials: L
authors.lastname: Vladi
authors.affiliation: Dipartimento del Cuore e dei Vasi, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
authors.forename: Miroslava
authors.initials: M
authors.lastname: Stolcova
authors.affiliation: Dipartimento del Cuore e dei Vasi, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
authors.forename: Serafina
authors.initials: S
authors.lastname: Valente
authors.affiliation: Dipartimento del Cuore e dei Vasi, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Meucci
authors.affiliation: Dipartimento del Cuore e dei Vasi, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
authors.forename: Giorgio Jacopo
authors.initials: GJ
authors.lastname: Baldereschi
authors.affiliation: Dipartimento del Cuore e dei Vasi, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Chiostri
authors.affiliation: Dipartimento del Cuore e dei Vasi, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
authors.forename: Salvatore Mario
authors.initials: SM
authors.lastname: Romano
authors.affiliation: Dipartimento del Cuore e dei Vasi, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
authors.affiliation: Epidemiology Unit, Local Health 10, Florence, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Barchielli
authors.affiliation: Epidemiology Unit, Local Health 10, Florence, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Balzi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents / Q000009:adverse effects; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D015607:Stents / Q000009:adverse effects; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D008670:Metals
keywords: Bare metal stent; Drug-eluting stent; Outcome; Primary PCI; STEMI