title: Selective use of contemporary drug-eluting stents in primary angioplasty for ST-elevation myocardial infarction: pooled analysis of COMFORTABLE AMI and EXAMINATION.
abstract: OBJECTIVE
  Selective use of DES only in patients at higher risk of MACE is common practice, particularly in healthcare systems with a large premium payable for DES. We aimed to identify subgroups of patients in which the use of BMS in primary percutaneous coronary intervention (PPCI) for STEMI can still be justified.
  
  
  RESULTS
  We performed a patient-level pooled analysis of COMFORTABLE AMI and EXAMINATION comparing contemporary DES with BMS in PPCI. A risk score was applied using three parameters: lesion length >15 mm, vessel size <3 mm, and diabetes mellitus. Individual data were available for 2,655 patients. The incidence of MACE at one year was incrementally higher in patients with risk scores of 1 or 2/3. MACE rates were lower in patients with a risk score 0 or 1 who were treated with DES (p=0.0073 and p=0.008). No difference in death or reinfarction was seen between DES and BMS in any group. There was a significant reduction in TLR with DES in all three groups.
  
  
  CONCLUSIONS
  A score comprising vessel size, lesion length, and diabetes did not identify patients at low risk with equivalent or better results from BMS use. The results suggest that the practice of only selective use of DES in primary PCI should be discouraged.
authors.affiliation: Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
authors.forename: Andreas
authors.initials: A
authors.lastname: Baumbach
authors.forename: Dik
authors.initials: D
authors.lastname: Heg
authors.forename: Lorenz
authors.initials: L
authors.lastname: Räber
authors.forename: Miodrag
authors.initials: M
authors.lastname: Ostoijc
authors.forename: Salvatore
authors.initials: S
authors.lastname: Brugaletta
authors.forename: Julian W
authors.initials: JW
authors.lastname: Strange
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Johnson
authors.forename: Peter
authors.initials: P
authors.lastname: Juni
authors.forename: Thomas
authors.initials: T
authors.lastname: Engstrøm
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Manel
authors.initials: M
authors.lastname: Sabate
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D002986:Clinical Trials as Topic; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000379:methods; D012307:Risk Factors; D016896:Treatment Outcome