title: Drug-eluting stents vs. bare metal stents in patients with cardiogenic shock: a comparison by propensity score analysis.
abstract: BACKGROUND
  In patients with cardiogenic shock, data on the comparative safety and efficacy of drug-eluting stents (DESs) vs. bare metal stents (BMSs) are lacking. We sought to assess the performance of DESs compared with BMSs among patients with cardiogenic shock undergoing percutaneous coronary intervention (PCI).
  
  
  METHODS
  Out of 236 patients with acute coronary syndromes complicated by cardiogenic shock, 203 were included in the final analysis. The primary endpoint included death, and the secondary endpoint of major adverse cardiac and cerebrovascular events (MACCEs) included the composite of death, myocardial infarction, any repeat revascularization and stroke. Patients were followed for a minimum of 30 days and up to 4 years. As stent assignment was not random, we performed a propensity score analysis to minimize potential bias.
  
  
  RESULTS
  Among patients treated with DESs, there was a lower risk of the primary and secondary endpoints compared with BMSs at 30 days (29 vs. 56%, P < 0.001; 34 vs. 58%, P = 0.001, respectively) and during long-term follow-up [hazard ratio 0.43, 95% confidence interval (CI) 0.29-0.65, P < 0.001; hazard ratio 0.49, 95% CI 0.34-0.71, P < 0.001, respectively]. After propensity score adjustment, all-cause mortality was reduced among patients treated with DESs compared with BMSs both at 30 days [adjusted odds ratio (OR) 0.26, 95% CI 0.11-0.62; P = 0.002] and during long-term follow-up (adjusted hazard ratio 0.40, 95% CI 0.22-0.72; P = 0.002). The rate of MACCE was lower among patients treated with DESs compared with those treated with BMSs at 30 days (adjusted OR 0.42, 95% CI 0.19-0.95; P = 0.036). The difference in MACCEs between devices approached significance during long-term follow-up (adjusted hazard ratio 0.60, 95% CI 0.34-1.01; P = 0.052).
  
  
  CONCLUSIONS
  DESs appear to be associated with improved clinical outcomes, including a reduction in all-cause mortality compared with BMSs among patients undergoing PCI for cardiogenic shock, possibly because of a pacification of the infarct-related artery by anti-inflammatory drug. The results of this observational study require confirmation in an appropriately powered randomized trial.
authors: aUniversity Heart Center, Department of Cardiology, University Hospital Zurich bDivision of Biostatistics, ISPM, University Zurich, Zurich, Switzerland cCardiovascular Center, University of Michigan, Ann Arbor, Michigan, USA dDepartment of Cardiology, Bern University Hospital, Bern, Switzerland *Dr Milosz Jaguszewski and Dr Jelena-Rima Ghadri contributed equally to this work and are shared first authors.
authors: Milosz
authors: M
authors: Jaguszewski
authors: Jelena-Rima
authors: JR
authors: Ghadri
authors: Burkhardt
authors: B
authors: Seifert
authors: Thierry
authors: T
authors: Hiestand
authors: Paola
authors: P
authors: Herrera
authors: Oliver
authors: O
authors: Gaemperli
authors: Ulf
authors: U
authors: Landmesser
authors: Willibald
authors: W
authors: Maier
authors: Brahmajee K
authors: BK
authors: Nallamothu
authors: Stephan
authors: S
authors: Windecker
authors: Thomas F
authors: TF
authors: Lüscher
authors: Christian
authors: C
authors: Templin
mesh_terms: D000368:Aged; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation* / Q000706:statistics & numerical data; D057216:Propensity Score; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000601:surgery*; D016896:Treatment Outcome