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Comparison of Drug-Eluting Stents Versus Bare-Metal Stents for Treating ST-Segment Elevation Myocardial Infarction

Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.

^_* Reprint requests and correspondence: Dr. Sorin J. Brener, Associate Professor of Medicine, Director, Cardiac Catheterization Laboratory and Interventional Cardiology, NY Methodist Hospital, 506 Sixth Street, Brooklyn, New York 11215. (Email: sjb9005{at}nyp.org).

Objectives: We sought to examine the clinical outcomes of patients treated with drug-eluting stents (DES) compared with bare-metal stents (BMS) during primary angioplasty for ST-segment elevation myocardial infarction (STEMI).

Background: Pathophysiologic studies suggest that the use of DES for STEMI may be associated with stent thrombosis and increased clinical events. However, although short-term data exist, long-term follow-up is lacking.

Methods: Patients who presented with STEMI from January 2002 to May 2007 to our institution were included. In addition to multivariable adjusted analysis, propensity analysis for stent choice was performed. The primary end point was the composite of death or target lesion revascularization (TLR).

Results: Of the 804 patients, 699 underwent stenting and met our study criteria. There were 152 composite events over a median follow-up of 1.7 years. In a multivariable Cox model, DES use was associated with a trend toward lower death or TLR compared with BMS (adjusted hazard ratio [HR] 0.72, 95% confidence interval [CI], 0.50 to 1.02, p = 0.06). However, this was mainly due to lower TLR (adjusted HR 0.60, 95% CI, 0.36 to 0.98, p = 0.043). Similarly, DES was associated with a trend toward lower death or TLR compared with BMS in the propensity-matched patients (adjusted HR 0.65, 95% CI 0.42 to 1.00, p = 0.05). This was mainly due to lower TLR in the DES patients (adjusted HR 0.52, 95% CI 0.28 to 0.96, p = 0.04).

Conclusions: Both DES and BMS are effective in the setting of STEMI; however, DES is associated with lower TLR without an increase in all-cause mortality.

Abbreviations and Acronyms   BMS = bare-metal stent(s)   CI = confidence interval   DES = drug-eluting stent(s)   HR = hazard ratio   PCI = percutaneous coronary intervention   RCT = randomized clinical trial   STEMI = ST-segment elevation myocardial infarction   TLR = target lesion revascularization

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Drug-Eluting Stents for ST-Segment Elevation Myocardial Infarction: Treatment of Choice or Is Discretion the Better Part of Valor?

Charanjit S. Rihal
J. Am. Coll. Cardiol. Intv. 2008 1: 233-235. [Full Text] [PDF]

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				C. S. Rihal Drug-Eluting Stents for ST-Segment Elevation Myocardial Infarction: Treatment of Choice or Is Discretion the Better Part of Valor? J. Am. Coll. Cardiol. Intv., June 1, 2008; 1(3): 233 - 235. [Full Text] [PDF]