Clinical outcomes of drug-eluting stents versus bare-metal stents in patients with cardiogenic shock complicating acute myocardial infarction.
BACKGROUND
To investigate the cardiovascular (CV) outcomes of drug-eluting stents (DESs) versus bare-metal stents (BMSs) in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS).


METHODS
Data from the Taiwan National Health Insurance Research Database was analyzed between January 1, 2007 and December 31, 2011. A total of 3051 AMI patients in CS were selected as the study cohort. Their clinical outcomes were evaluated by comparing 1017 subjects who used DESs to 2034 matched subjects who used BMSs.


RESULTS
The risk of the primary composite outcome (i.e., death, myocardial infarction, stroke, and coronary revascularization) was significantly lower in the DES group compared with the BMS group [56.1% vs. 66.2%, hazard ratio (HR), 0.74; 95% CI, 0.67-0.81] with a mean follow-up of 1.35years. The patients who received DESs had a lower risk of coronary revascularization (HR, 0.78; 95% CI, 0.67-0.91) and death (HR, 0.70; 95% CI, 0.62-0.79) than those who used BMSs. However, the risks of myocardial infarction (HR, 0.89; 95% CI, 0.66-1.18), ischemic stroke (HR, 1.02; 95% CI, 0.67-1.53) and major bleeding (HR, 0.80; 95% CI, 0.56-1.14) were similar between the two groups.


CONCLUSIONS
Among patients with CS complicating AMI, DES implantation significantly reduced the risk of percutaneous coronary revascularization and death compared to BMS implantation.
Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Dong-Yi
DY
Chen
Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan,; Chang Gung University College of Medicine, Taoyuan, Taiwan.
Chun-Tai
CT
Mao
Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Ming-Lung
ML
Tsai
Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Shao-Wei
SW
Chen
Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
Yu-Sheng
YS
Lin
Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
I-Chang
IC
Hsieh
Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan,; Chang Gung University College of Medicine, Taoyuan, Taiwan.
Ming-Jui
MJ
Hung
Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan,; Chang Gung University College of Medicine, Taoyuan, Taiwan.
Chao-Hung
CH
Wang
Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Ming-Shien
MS
Wen
Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan,; Chang Gung University College of Medicine, Taoyuan, Taiwan.
Wen-Jin
WJ
Cherng
Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan,; Chang Gung University College of Medicine, Taoyuan, Taiwan. Electronic address: skyheart7687@gmail.com.
Tien-Hsing
TH
Chen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D054855:Drug-Eluting Stents / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D011159:Population Surveillance; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D015607:Stents / Q000639:trends; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
D008670:Metals
Acute myocardial infarction; Bare-metal stent; Cardiogenic shock; Drug-eluting stent