This Article Full Text Full Text (PDF) All Versions of this Article: 1/2/103    most recent CIRCINTERVENTIONS.108.787762v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kukreja, N. Articles by Serruys, P. W. Search for Related Content PubMed PubMed Citation Articles by Kukreja, N. Articles by Serruys, P. W. Related Collections Acute myocardial infarction Catheter-based coronary interventions: stents Related Articles

Original Articles

Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction

Long-Term Outcome After Bare Metal and Drug-Eluting Stent Implantation

Neville Kukreja, MA, MRCP; Yoshinobu Onuma, MD; Hector Garcia-Garcia, MD; Joost Daemen, MD; Ron van Domburg, MD, PhD and Patrick W. Serruys, MD, PhD

From the Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands.

Correspondence to Patrick W. Serruys, MD, PhD, Thoraxcenter, Ba-583, ‘s Gravendijkwal 230, 3015 CE Rotterdam, Netherlands. E-mail p.w.j.c.serruys{at}erasmusmc.nl

Received April 22, 2008; accepted August 18, 2008.

Background— Primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction with bare metal stents (BMS) is well established, while randomized trials suggest equivalent safety and reduced repeat revascularization with drug-eluting stents (DES) in this setting. However, long-term data on DES in PPCI is lacking, especially in those ineligible for inclusion in randomized trials. Our aim was to investigate the long-term outcomes of unselected patients undergoing PPCI with BMS and DES.

Methods and Results— We analyzed all patients (n=1738) undergoing PPCI for a de novo lesion in our institution from 2000 to 2005. Patients from 3 sequential consecutive cohorts of BMS (n=531), sirolimus-eluting (SES, n=185) or paclitaxel-eluting stents (PES, n=1022) were included. The median duration of follow-up was 1185 days (interquartile range, 746 to 1675). There were no differences in all-cause mortality or repeat revascularization between DES and BMS, although there was a nonsignificant trend toward improved survival with SES compared with both BMS (propensity score-adjusted hazard ratio, 0.63; [95%CI, 0.33 to 1.18]) and PES (hazard ratio, 0.71; [95% CI, 0.40 to 1.26]). SES were associated with lower rates of the composite end point of all-cause death, nonfatal myocardial infarction, or target vessel revascularization (hazard ratio, 0.62; 95%CI, 0.40 to 0.96) when compared with PES. Very late stent thrombosis only occurred in the DES groups.

Conclusions— Although DES are not associated with an increase in adverse events compared with BMS when used for PPCI, neither DES reduced repeat revascularizations. Appropriately powered randomized trials with hard clinical end points and an "all-comer" design are required to further assess the benefit of DES in PPCI.

Key Words: angioplasty • mortality • myocardial infarction • stents

---

 

CLINICAL PERSPECTIVE

Related Articles

Primary Percutaneous Coronary Intervention With Drug-Eluting Stents: Another Chapter in the Stent Controversy

Eric R. Bates
Circ Cardiovasc Interv 2008 1: 87-89. [Extract] [Full Text] [PDF]

Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction: Long-Term Outcome After Bare Metal and Drug-Eluting Stent Implantation

Neville Kukreja, Yoshinobu Onuma, Hector Garcia-Garcia, Joost Daemen, Ron van Domburg, and Patrick W. Serruys
Circ Cardiovasc Interv 2008 1: 103-110. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

				Y. Onuma, N. Kukreja, N. Piazza, J. Eindhoven, C. Girasis, L. Schenkeveld, R. van Domburg, P. W. Serruys, and Interventional Cardiologists of the Thoraxcenter ( The Everolimus-Eluting Stent in Real-World Patients: 6-Month Follow-Up of the X-SEARCH (Xience V Stent Evaluated at Rotterdam Cardiac Hospital) Registry J. Am. Coll. Cardiol., July 14, 2009; 54(3): 269 - 276. [Abstract] [Full Text] [PDF]

				S. R. Dixon, C. L. Grines, and W. W. O'Neill The year in interventional cardiology. J. Am. Coll. Cardiol., June 2, 2009; 53(22): 2080 - 2097. [Full Text] [PDF]

				S. S. Brar, M. B. Leon, G. W. Stone, R. Mehran, J. W. Moses, S. K. Brar, and G. Dangas Use of drug-eluting stents in acute myocardial infarction: a systematic review and meta-analysis. J. Am. Coll. Cardiol., May 5, 2009; 53(18): 1677 - 1689. [Abstract] [Full Text] [PDF]

				E. R. Bates Primary Percutaneous Coronary Intervention With Drug-Eluting Stents: Another Chapter in the Stent Controversy Circ Cardiovasc Interv, October 1, 2008; 1(2): 87 - 89. [Full Text] [PDF]