title: Five-year outcomes of ST-elevation myocardial infarction versus non-ST-elevation acute coronary syndrome treated with biodegradable polymer-coated sirolimus-eluting stents: Insights from the CREATE trial.
abstract: Long-term outcome of drug-eluting stents (DES) for ST-elevation myocardial infarction (STEMI) versus non-ST-elevation acute coronary syndrome (NSTE-ACS) remains unclear. This study sought to compare the long-term outcomes of biodegradable polymer-coated DES in patients with STEMI versus NSTE-ACS.
  
  
  
  We explored a post hoc analysis of the 5-year outcome of the CREATE trial in the subgroup of patients with STEMI (n=318) versus NSTE-ACS (n=1223) who were implanted with biodegradable polymer-coated DES. The primary outcome was the rate of major adverse cardiac events (MACE) at 5 years. Clopidogrel and aspirin for 6 months followed by chronic aspirin therapy were recommended.
  
  
  
  STEMI patients showed a trend of increase in MACE (8.7% vs. 6.8%, log rank p=0.289) compared to NSTE-ACS patients at 5 years, and a greater risk of cardiac death (5.4% vs. 2.1%, log rank p=0.003), mainly driven by the higher cardiac death rate within the first month after stent placement (log rank p=0.003) and the last year of follow-up (log rank p=0.001). No significant difference in stent thrombosis was found between them (3.1% vs. 2.5%, log rank p=0.653). Prolonged clopidogrel therapy (>6 months) showed no effect on risk of MACE or stent thrombosis between the two groups (both p for interaction >0.1).
  
  
  
  STEMI patients have a higher risk of cardiac mortality compared with NSTE-ACS patients after biodegradable polymer-coated DES placement, primarily attribute to more cardiac deaths that happened within the first month after the event and the last year of follow-up.
authors.affiliation: General Hospital of Chinese People's Armed Police Forces, Beijing, China.
authors.forename: Hui-Liang
authors.initials: HL
authors.lastname: Liu
authors.affiliation: General Hospital of Chinese People's Armed Police Forces, Beijing, China.
authors.forename: Zhi-Geng
authors.initials: ZG
authors.lastname: Jin
authors.affiliation: General Hospital of Chinese People's Armed Police Forces, Beijing, China.
authors.forename: Sheng-Li
authors.initials: SL
authors.lastname: Yang
authors.affiliation: General Hospital of Chinese People's Armed Police Forces, Beijing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Han
authors.affiliation: Shenyang Northern Hospital, Shenyang, Liaoning, China.
authors.forename: Quan-Min
authors.initials: QM
authors.lastname: Jing
authors.affiliation: Shenyang Northern Hospital, Shenyang, Liaoning, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: General Hospital of Chinese People's Armed Police Forces, Beijing, China.
authors.forename: Jian-Ping
authors.initials: JP
authors.lastname: Luo
authors.affiliation: General Hospital of Chinese People's Armed Police Forces, Beijing, China.
authors.forename: Dong-Xing
authors.initials: DX
authors.lastname: Ma
authors.affiliation: General Hospital of Chinese People's Armed Police Forces, Beijing, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Kunming General Hospital of Chengdu Military Region, Kunming, China.
authors.forename: Li-Xia
authors.initials: LX
authors.lastname: Yang
authors.affiliation: Affiliated Hospital of Chinese People's Armed Police Forces Medical College, Tianjin, China.
authors.forename: Tie-Min
authors.initials: TM
authors.lastname: Jiang
authors.affiliation: The Second Affiliated Hospital of Dalian Medical University, Dalian, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Qu
authors.affiliation: The First Clinical Medical College of Harbin Medical University, Harbin, China.
authors.forename: Wei-Min
authors.initials: WM
authors.lastname: Li
authors.affiliation: The Second Hospital of Jilin University, Changchun, China.
authors.forename: Shu-Mei
authors.initials: SM
authors.lastname: Li
authors.affiliation: FuWai Hospital, Beijing, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Xu
authors.affiliation: FuWai Hospital, Beijing, China.
authors.forename: Run-Lin
authors.initials: RL
authors.lastname: Gao
authors.affiliation: Shenyang Northern Hospital, Shenyang, Liaoning, China. Electronic address: yalinghan_nh@126.com.
authors.forename: Ya-Ling
authors.initials: YL
authors.lastname: Han
mesh_terms: D020341:Absorbable Implants / Q000706:statistics & numerical data; D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000601:surgery*; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011108:Polymers; D000072657:ST Elevation Myocardial Infarction / Q000188:drug therapy / Q000601:surgery*; D020123:Sirolimus / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D011108:Polymers; D020123:Sirolimus
keywords: Acute coronary syndrome; Biodegradable polymer; Drug eluting stent; Myocardial infarction