Drug-Eluting Versus Bare-Metal Stents in the Treatment of Patients With ST-Segment Elevation Myocardial Infarction
Edward L. Hannan, PhD*,*,
Michael Racz, PhD ,
Gary Walford, MD ,
David R. Holmes, MD ,
Robert H. Jones, MD||,
Samin Sharma, MD¶,
Stanley Katz, MD#,
Spencer B. King, III, MD, MACC**
* University at Albany, State University of New York, Albany, New York
New York State Department of Health, Albany, New York
St. Joseph’s Hospital, Syracuse, New York
Mayo Clinic, Rochester, Minnesota
|| Duke University Medical Center, Durham, North Carolina
¶ Mt. Sinai Medical Center, New York, New York
# North Shore-LIJ Health System, Manhasset, New York
** Fuqua Heart Center/Piedmont Hospital, Atlanta, Georgia.
* Reprint requests and correspondence: Dr. Edward L. Hannan, School of Public Health, State University of New York, Department of Health Policy, Management, and Behavior, SUNY University at Albany, One University Place, Rensselaer, New York 12144-3456. (Email: elh03{at}health.state.ny.us).
Objectives: The purpose of this study was to compare outcomes for drug-eluting stents (DES) and bare-metal stents (BMS) for patients with ST-segment elevation myocardial infarction (STEMI).
Background: Despite some controversy related to late stent thromboses, DES are approved for use in many patients undergoing stenting. However, there are several types of patients in whom implanting a DES would be regarded as off-label use, and this study compares DES and BMS for one of these groups.
Methods: New York’s percutaneous coronary intervention registry was used to identify 772 patients undergoing percutaneous coronary intervention (PCI) for STEMI who received BMS and 1,154 STEMI patients who received DES between October 1, 2003, and December 31, 2004. These patients were tracked through December 31, 2005. Mortality, target vessel PCI, and subsequent coronary artery bypass graft (CABG) surgery within 2 years of undergoing the procedure were captured. Adverse outcomes were adjusted using proportional hazards methods to account for baseline differences in patients’ severity of illness.
Results: The BMS patients had significantly higher mortality (adjusted hazard ratio [HR] vs. DES = 2.01, 95% confidence interval [CI] 1.21 to 3.34, risk-adjusted mortality = 8.6% vs. 5.0%, p = 0.007) and significantly higher subsequent CABG surgery (adjusted HR vs. DES = 2.33, 95% CI 1.31 to 4.16, risk-adjusted rate = 6.4% vs. 3.0%, p = 0.004) rates. There was no difference by type of DES (adjusted HR for paclitaxel-eluting stent versus sirolimus-eluting stent; mortality 0.72, 95% CI 0.30 to 1.72), subsequent CABG surgery (adjusted HR = 0.60, 95% CI 0.26 to 1.40), and target vessel PCI (adjusted HR = 0.74, 95% CI 0.35 to 1.58).
Conclusions: In this observational study, DES were associated with lower mortality and subsequent CABG surgery when used for STEMI patients.
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Abbreviations and Acronyms
| | BMS = bare-metal stent(s) | | CABG = coronary artery bypass graft | | DES = drug-eluting stent(s) | | HR = hazard ratio | | IV = intravenous | | PCI = percutaneous coronary intervention | | PCIRS = Percutaneous Coronary Interventions Reporting System | | PES = paclitaxel-eluting stent(s) | | RCT = randomized controlled trial | | SES = sirolimus-eluting stent(s) | | STEMI = ST-segment elevation myocardial infarction |
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