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From 2007 through 2013, bare metal stents (BMS) were the guidelines recommended option for percutaneous coronary intervention (PCI). We sought to analyze trends and in-hospital outcomes of patients treated with BMS or drug eluting stents (DES) during primary angioplasty for ST segment elevation myocardial infarction (STEMI). Not many studies have been done on a large scale data comparing type of stent used for percutaneous coronary intervention (PCI).
With the use of nationwide inpatient sample database from 2007-2013, we have identified 180,734 STEMI patients undergoing PCI using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) codes (DES-36.07, BMS-36.06). Analysis was performed using SAS 9.4 (SAS Institute Inc, Cary, North Carolina). Missing data on in-hospital outcomes and age were excluded from our study.
Overall, the number of STEMI patients undergoing PCI from 2007-2013 has been decreasing; however their age has been increasing. Patients receiving DES had more comorbidities, however even after correcting for confounders, lower in-hospital mortality and length of stay (LOS) was seen in patients receiving DES as compared to BMS (Ptrend <0.0001). Secondary outcomes including acute renal failure, stroke, cardiogenic shock, acute pulmonary edema, gastrointestinal hemorrhage, blood loss requiring transfusion, cardiac arrest and LOS were noted significantly lower with DES compared to BMS (P<0.0001).
BMS have been the preferred and recommended device for use in STEMI for years, however this data adds to the mounting evidence that DES should be considered the preferred option. This study demonstrates DES is associated with a significant reduction in length of stay and in-hospital mortality.