Published Online
on September 3, 2008

A more recent version of this article appeared on October 1, 2008

This Article 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 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 Articles by Kukreja, N. Articles by Serruys, P. W. Related Collections Acute myocardial infarction Catheter-based coronary interventions: stents Related Articles

Original Article

Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction: Long-term Outcome Following Bare Metal and Drug-eluting Stent Implantation

Neville Kukreja; Yoshinobu Onuma; Hector M. Garcia-Garcia; Joost Daemen; Ron T. van Domburg and Patrick W. Serruys¹

Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands

¹ E-mail: p.w.j.c.serruys{at}erasmusmc.nl

Background—Primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction with bare metal stents (BMS) is well established, whilst 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 2000-2005. 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 746-1675). There were no differences in all-cause mortality or repeat revascularization between DES and BMS, although there was a non-significant trend towards improved survival with SES compared to both BMS (propensity score-adjusted HR 0.63 [95%CI 0.33-1.18]) and PES (HR 0.71 [95% CI 0.40-1.26]). SES were associated with lower rates of the composite endpoint of all-cause death, nonfatal myocardial infarction or target vessel revascularization (HR 0.62, 95%CI 0.40-0.96) when compared to PES. Very late stent thrombosis only occurred in the DES groups.

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

Key Words: angioplasty • mortality • myocardial infarction • stents

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				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]