title: Long-term outcomes following drug-eluting stents versus bare metal stents for primary percutaneous coronary intervention: A real-world analysis of 11,181 patients from the british columbia cardiac registry.
abstract: BACKGROUND
  Drug eluting stents (DES) are associated with reduced risk of restenosis when compared with bare metal stents (BMS). Their use in ST-elevation myocardial infarction (STEMI) is debated, owing to concerns about stent thrombosis. There are limited real-world data comparing DES versus BMS in STEMI. We conducted an observational analysis in this setting and rigorously adjusted for treatment selection bias.
  
  
  METHODS
  We analyzed 11,181 consecutive patients with acute STEMI who received either DES or BMS during 2008-2014 in the British Columbia Cardiac Registry. We analyzed target vessel revascularization (TVR) and mortality at 2 years.
  
  
  RESULTS
  Multivariable-adjusted, propensity-matched and inverse probability-treatment weighted analyses found DES to be associated with early and late survival up to 2 years but not TVR. However, when adjusting for measured and unmeasured confounders, instrumental variable (IV) analyses demonstrated that DES use was associated with reduced TVR up to 2 years (Δ = -6.7%, 95% CI: -10.0%, -3.4%, P < 0.001). DES use was not associated with mortality at 1 year (Δ = -2.3%, 95% CI: -5.0%, 0.4%, P = 0.100) but associated with reduced mortality at 2 years (Δ = -5.4%, 95% CI: -8.3%, -2.5%, P < 0.001). Stratified IV analyses indicated that this long-term survival benefit was largely attributable to the second generation DES.
  
  
  CONCLUSIONS
  In this study of patients with STEMI, when adjusting for measured and unmeasured factors, DES use was associated with reduced TVR and long-term survival beyond 1 year. This long-term survival was largely attributable to the second generation DES. These real-world data are reassuring and support the use of DES for STEMI. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Victoria Heart Institute Foundation, Victoria, British Columbia, Canada.|Royal Jubilee Hospital, Victoria, British Columbia, Canada.
authors.forename: M Bilal
authors.initials: MB
authors.lastname: Iqbal
authors.affiliation: Victoria Heart Institute Foundation, Victoria, British Columbia, Canada.|Royal Jubilee Hospital, Victoria, British Columbia, Canada.
authors.forename: Imad J
authors.initials: IJ
authors.lastname: Nadra
authors.affiliation: Provincial Health Services Authority, Vancouver, British Columbia, Canada.
authors.forename: Lillian
authors.initials: L
authors.lastname: Ding
authors.affiliation: Vancouver General Hospital, Vancouver, British Columbia, Canada.
authors.forename: Anthony
authors.initials: A
authors.lastname: Fung
authors.affiliation: St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Eve
authors.initials: E
authors.lastname: Aymong
authors.affiliation: Royal Columbian Hospital, Vancouver, British Columbia, Canada.
authors.forename: Albert W
authors.initials: AW
authors.lastname: Chan
authors.affiliation: Kelowna General Hospital, Kelowna, British Columbia, Canada.
authors.forename: Steven
authors.initials: S
authors.lastname: Hodge
authors.affiliation: Victoria Heart Institute Foundation, Victoria, British Columbia, Canada.|Royal Jubilee Hospital, Victoria, British Columbia, Canada.
authors.forename: Simon D
authors.initials: SD
authors.lastname: Robinson
authors.affiliation: Victoria Heart Institute Foundation, Victoria, British Columbia, Canada.|Royal Jubilee Hospital, Victoria, British Columbia, Canada.
authors.forename: Anthony Della
authors.initials: AD
authors.lastname: Siega
mesh_terms: D001955:British Columbia; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008670:Metals; D008875:Middle Aged; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D057216:Propensity Score; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008670:Metals
keywords: bare metal stent; drug-eluting stent; mortality; primary percutaneous coronary intervention; target vessel revascularization