title: Drug-eluting versus bare-metal stents in large coronary arteries of patients with ST-segment elevation myocardial infarction: findings from the ICAS registry.
abstract: OBJECTIVE
  There are a few retrospective subgroup analyses or registries of large-vessel (≥ 3.5mm) stenting. We investigated clinical outcomes of patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and bare-metal stents (BMS) in large coronary vessels.
  
  
  METHODS
  Of 1100 STEMI patients registered in the Ibaraki Cardiovascular Assessment Study (ICAS) multicenter registry from April 2007 to June 2012 who underwent PCI, we enrolled 454 patients (65.8 ± 12.7 years old, 81% male) with ≥ 3.5-mm stents. We excluded 53 patients with cardiogenic shock or left main trunk lesions. The remaining 401 patients were divided into Group-D, PCI with DES (n = 184), and Group-B, PCI with BMS (n = 217). Propensity score analysis matched 1:1 according to treatment with DES (n = 101) or with BMS (n = 101). We evaluated major adverse cardiac and cerebrovascular events (MACCE) and incidence of stent thrombosis (ST). MACCE was defined as all-cause death, myocardial infarction (MI), target-vessel revascularization (TVR), or cerebrovascular accident (CVA).
  
  
  RESULTS
  During a mean follow-up period of 526 days, all-cause death, MI, CVA, MACCE, and ST were not significantly different in Group-D versus Group-B (all-cause death: 4.35% vs. 4.61%, p = 0.90; MI: 0% vs. 0%; CVA: 2.72% vs. 3.23%, p = 0.76; MACCE: 15.2% vs. 20.3%, p = 0.19; and ST: 0.0% vs. 1.38%, p = 0.11). After adjusting for age, insulin use, multivessel disease, intra-aortic balloon pump use, culprit lesions, and estimated glomerular filtration rate <60 ml/min/1.73 m(2), MACCE was not significantly different between the groups (odds ratio: 0.69; 95% CI: 0.40-1.23; p = 0.21). However, TVR was significantly lower in Group-D than Group-B in Kaplan-Meier analysis (p = 0.048) after propensity score matching.
  
  
  CONCLUSIONS
  There was no advantage to using a DES in large vessels for preventing a hard endpoint, whereas DES use resulted in a significant reduction in TVR in the patients with STEMI in this registry.
authors.affiliation: Department of Cardiology, Ibaraki Prefectural Central Hospital, Tomobe, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Abe
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. Electronic address: asato@md.tsukuba.ac.jp.
authors.forename: Akira
authors.initials: A
authors.lastname: Sato
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Hoshi
authors.affiliation: Department of Cardiology, Ibaraki Prefectural Central Hospital, Tomobe, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Maruta
authors.affiliation: Department of Cardiology, Ibaraki Prefectural Central Hospital, Tomobe, Japan.
authors.forename: Masako
authors.initials: M
authors.lastname: Misaki
authors.affiliation: Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Kakefuda
authors.affiliation: Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Watabe
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Daigo
authors.initials: D
authors.lastname: Hiraya
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Sakai
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kawabe
authors.affiliation: Department of Cardiology, Ibaraki Prefectural Central Hospital, Tomobe, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Takeyasu
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aonuma
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002423:Cause of Death; D054855:Drug-Eluting Stents; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000453:epidemiology; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008670:Metals
keywords: Drug-eluting stent; Large coronary; ST-segment elevation myocardial infarction