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Original Articles

Clinical Outcome After Primary Percutaneous Coronary Intervention With Drug-Eluting and Bare Metal Stents in Patients With ST-Segment Elevation Myocardial Infarction

Lisette Okkels Jensen, MD, PhD; Michael Maeng, MD, PhD; Per Thayssen, MD, DMSci; Anne Kaltoft, MD, PhD; Hans Henrik Tilsted, MD; Morten Bøttcher, MD, PhD; Jens Flensted Lassen, MD, PhD; Knud Nørregaard Hansen, MD; Lars Romer Krusell, MD; Klaus Rasmussen, MD, DMSci; Knud Erik Pedersen, MD, DMSci; Lars Pedersen, MSc; Søren Paaske Johnsen, MD, PhD; Henrik Toft Sørensen, MD, PhD, DMSci and Leif Thuesen, MD; DMSci

From the Department of Cardiology (L.O.J., P.T., K.N.H., K.E.P.), Odense University Hospital, Odense, Denmark; the Department of Cardiology (M.M., A.K., M.B., J.F.L., L.R.K., L.T.), Skejby Sygehus, Aarhus University Hospital, Aarhus, Denmark; the Department of Cardiology (H.H.T., K.R.) and the Center for Cardiovascular Research (K.R., S.P.J.), Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark; the Department of Clinical Epidemiology (L.P., S.P.J., H.T.S.), Aarhus University Hospital, Aarhus, Denmark; and the Department of Epidemiology (H.T.S.), Boston University, Boston, Mass.

Correspondence to Lisette Okkels Jensen, MD, PhD, Department of Cardiology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark. E-mail okkels{at}dadlnet.dk

Received May 27, 2008; accepted October 16, 2008.

Background— The use of drug-eluting stents (DESs) versus bare metal stents (BMSs) in primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction is a matter of debate. Therefore, we examined the risk of target lesion revascularization (TLR), stent thrombosis, myocardial infarction, and death after the implantation of DES or BMS in primary PCI patients in Western Denmark.

Methods and Results— A total of 3756 consecutive patients with ST-segment elevation myocardial infarction treated with primary PCI and stent implantation, recorded in the Western Denmark Heart Registry from January 2002 through June 2005, were followed up for 2 years. We used Cox regression analysis to control for confounding. The 2-year incidence of definite stent thrombosis was 1.9% in the DES group and 1.1% in the BMS group (adjusted relative risk [RR]=1.53; 95% CI=0.84 to 2.78; P=0.17). Very late definite stent thrombosis (12 months) was seen in 0.4% in the DES group and 0.06% in the BMS group (adjusted RR=6.74; 95% CI=1.23 to 37.00; P=0.03). The 2-year incidence of myocardial infarction was similar in the 2 groups, 5.2% in the DES group versus 6.3% in the BMS group (P=0.28; adjusted RR=1.13; 95% CI=0.81 to 1.59; P=0.47). All-cause 2-year mortality was 7.8% in the DES group and 11.4% in BMS group (P<0.004; adjusted RR=0.79; 95% CI=0.60 to 1.04; P=0.09). The 2-year incidence of target lesion revascularization was 7.2% in the DES group and 8.7% in the BMS group (P=0.09; adjusted RR=0.70; 95% CI=0.52 to 0.92; P=0.012).

Conclusions— In ST-segment elevation myocardial infarction patients treated with primary PCI, target lesion revascularization was reduced by 30% in patients treated with a DES. The risk of very late definite stent thrombosis was low but increased in patients treated with DES. DES was not associated with increased risk of myocardial infarction or death, when compared with BMS.

Key Words: mortality • myocardial infarction • primary PCI • restenosis • thrombosis

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