title: Very late hazard with stenting versus balloon angioplasty for ST-elevation myocardial infarction: a 16-year single-center experience.
abstract: OBJECTIVE
  This study compares very late outcomes following primary percutaneous coronary intervention for ST-elevation myocardial infarction (STEMI) with stenting versus balloon angioplasty (BA).
  
  
  BACKGROUND
  Stenting compared with BA for STEMI improves outcomes at 6-12 months, but comparisons beyond 6-12 months have not been studied. Recent studies have shown that stent thrombosis (ST) continues to increase beyond 3-5 years and may be higher with drug-eluting stents (DES) than bare metal stents (BMS). We hypothesized that there may be a very late hazard with stenting versus BA due to very late ST.
  
  
  METHODS
  From 1994 to 2010 consecutive patients with STEMI treated with BA (n = 601) or stenting (n = 1,594) were prospectively enrolled in our registry and followed for 1-16 years.
  
  
  RESULTS
  Patients treated with BA were older, were more often female, had more three-vessel disease, and had smaller vessels. Stented patients had trends for less stent/lesion thrombosis (ST/LT) and target vessel (TV) reinfarction at 1 year. In landmark analyses >1 year, stented patients had more very late ST/LT (6.1% vs. 2.9%, P = 0.002) and more TV reinfarction (7.9% vs. 3.1%, P < 0.001) which remained significant after adjusting for baseline risk. The greatest differences in very late outcomes were between DES and BA, but there were also significant differences between BMS and BA.
  
  
  CONCLUSIONS
  There appears to be a very late hazard with stenting versus BA for STEMI. These data should encourage new strategies for prevention of very late ST with both BMS and DES including the development of bio-absorbable polymers and stent platforms.
authors.affiliation: The LeBauer Cardiovascular Research Foundation, Greensboro, North Carolina.
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Brodie
authors.forename: Yashashwi
authors.initials: Y
authors.lastname: Pokharel
authors.forename: Ankit
authors.initials: A
authors.lastname: Garg
authors.forename: Grace
authors.initials: G
authors.lastname: Kissling
authors.forename: Charles
authors.initials: C
authors.lastname: Hansen
authors.forename: Sally
authors.initials: S
authors.lastname: Milks
authors.forename: Michael
authors.initials: M
authors.lastname: Cooper
authors.forename: Christopher
authors.initials: C
authors.lastname: McAlhany
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Stuckey
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000628:therapy*; D011446:Prospective Studies; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome