Abstract 2498: Do Drug-Eluting Stents Remain Superior to Bare Metal Stents in Patients with Acute Myocardial Infarction after 3 Years of Follow-Up? Insights into the RESEARCH and T-SEARCH Registries
Background Recently, sirolimus-eluting stents (SES) but not paclitaxel-eluting stents (PES) have been shown to be superior to bare-metal stents (BMS) in reducing the need for repeat revascularizations in patients with ST-segment elevation myocardial infarction (STEMI) at 1 year of follow-up. The long-term clinical impact of both drug-eluting stents as compared to bare metal stents (BMS) is currently unknown.
Methods Primary angioplasty was performed in a consecutive group of 505 patients; 183 patients treated with BMS, 186 patients treated with SES and 136 patients treated with PES. The occurrence of death, reinfarction, and repeat revascularization was assessed at 3 years of follow-up.
Results There were few differences among the 3 groups in both baseline and procedural characteristics. The cumulative incidences of death, non-fatal myocardial infarction (MI), target vessel revascularization (TVR) and MACE (the composite endpoint of death, MI and TVR) are shown in the table⇓ together with the adjusted hazard ratios (correcting for independent predictors of adverse events and differences between groups). The cumulative incidence of death or MI was comparable in all 3 groups: 16.6% in the BMS group, 14.6% in the SES group and 16.9% in the PES group. TVR was 12.0% in the BMS group, compared to 8.0% and 7.7% in the SES and PES group respectively (p=NS). The cumulative incidence of MACE was 25.5% in the BMS group compared to 17.9% and 21.4% in the SES and PES group respectively (p=NS). Stent thrombosis occurred in 2.4% of all patients (BMS:1.6%; SES:2.7%; PES:2.9%; p=NS).
Conclusions After 3 years of clinical follow-up, the use of both SES and PES was no longer associated with significantly lower rates of TVR and MACE in patients with STEMI. A high frequency of overall stent thrombosis was observed in both DES groups.